Where in the World is Tonja?

Sadly, back in the U.S. after having the ultimate public health experience!

It’s been a few months since I last posted, and I kind of have the best excuse…I was away in Ghana for over three months doing what I love to do most, using my skills to serve and help other people.

If you’ve read my other posts about Ghana, then you know just how much I love the country. People often ask me why I love Ghana but it’s hard for me to explain exactly why. What I am able to tell people doesn’t completely capture my depth of love for the country which I call my home away from home. I tell them that I feel more free in Ghana than I do in America. I tell them that there are things I don ’t have to worry about in Ghana that I do in the U.S.

There are benefits to living in America, and Ghana is by no means perfect, but…there’s no place like home…in Ghana. The people, the culture, the sounds, the languages; there’s so much to love.

This was the longest I’ve been in Ghana, and I’ve learned more than I ever before. I’ve learned more about the healthcare system and how more complex it is than I once thought. I’ve learned about the school system and changes that have been made which are affecting children all over the country. And I’ve learned about the government.

Change first starts at home, but I know that I’m called to do more. I also no longer feel bad for being called to do work outside of the U.S. I know that my borders expand beyond one city, one state, one nation, and one continent. And right now…Ghana is one of the places I’m called to.

Over the next few posts, I’ll share several stories about the work I did and the people I met.  

Until next time!

Sexual Assault Awareness Month

Every 92 seconds, an American is sexually assaulted; and every 9 minutes a child is sexually assulted.1 The numbers are heartbreaking. Each year, approximately 430,000 people living in the United States experience sexual assault, some of them children.2  

Data from 2018 estimated that 734,630 people were raped (threatened, attempted, or completed) in the U.S. alone.3 The number of individuals who self-reported also increased but less people reported to the police.3

What is Sexual Assault and Who’s at Risk?

Image by Stage 9

Rape, human trafficking, child sexual abuse, molestation, incest, sexual harassment, voyeurism, sexual exploitation, sexual violence; sexual assault is an umbrella term used to describe unwanted sexual contact of any kind.

Sexual assault can happen to anyone, regardless of how they dress, their sex, their race, or the choices they make.

Adults ages 18-34 are at a higher risk of rape and sexual assault (54%) than older adults ages 65+ (3%), adults ages 35-64 (28%), and children ages 12-17 (15%).2

One out of 6 women in America is a survivor of attempted or completed rape and Native American women are more likely to experience sexual assault when compared to women from other races.2  According to the 2016 National Institute of Justice study, Native American women are 2.5 times more likely to experience rape than white women, and more than half of Native American women have been sexually assaulted.4

What about Boys and Men?

In general, when we hear about sexual assault, we often think of women and girls. However, boys and men are impacted too.

I’ve heard stories about men who were ashamed of what they experienced, feeling as if their “manhood” or “masculinity” had been taken away from them. Feeling as if they were unable to speak up, not because people wouldn’t believe, but out of guilt and shame. Afraid that others would make fun of them or look down on them because of what they survived.

Three percent of American men have reported attempted or completed rape.2 With many survivors not reporting their incident, it is possible that the number of men who have actually experienced attempted or completed rape is much higher.

Long-Term Effects of Sexual Assault

A couple of years ago, I heard a woman sharing her experience as a survivor, and how the long-term impact she experienced when she was younger lingered into her adulthood. She described what it was like going to her annual women’s exam, and how she had to be sedated so that her gynecologist could conduct the exam.

The long-term effects of her experience are similar to other survivors.

  • 94% of women who are raped experience symptoms of post-traumatic stress disorder (PTSD) during the two weeks following the rape.2,5
  • 38% of victims of sexual violence experience work or school problems, which can include significant problems with a boss, coworker, or peer.2
  • 84% of survivors who were victimized by an intimate partner experience professional or emotional issues, including moderate to severe distress, or increased problems at work or school.2
  • 79% of survivors who were victimized by a family member, close friend or acquaintance experience professional or emotional issues, including moderate to severe distress, or increased problems at work or school.2

Signs of Abuse

People who experience sexual assault are likely to display signs of abuse.


  • Has difficulty walking or sitting
  • Suddenly refuses to change for gym or to participate in physical activities
  • Reports nightmares or bedwetting
  • Experiences a sudden change in appetite
  • Excessive talk about or knowledge of sexual topics
  • Becomes pregnant or contracts an STD, particularly if under 14
  • Runs away
  • Reports sexual abuse by a parent or other adult caregiver
  • Attaches very quickly to strangers or new adults in their environment
  • Not wanting to be left alone with certain people
  • Self-harming
  • Overly compliant behavior
  • Change in eating habits
  • Change in mood or personality

Mercer County Children’s Advocacy Center, 2018; RAINN 2020

Men and Women

  • Infidelity, sexual addiction.
  • Complete disinterest in sex.
  • Unusual sexual or sexualized behaviors.
  • Porn addiction.
  • Strong emotional reactions to the mention of sexual abuse of others.
  • Depression, anxiety, self-harm.
  • Abuse of alcohol or other drugs.
  • Very protective behaviors towards children

Living Well, 2016

Every situation is different, and survivors may experience different signs of being abused. Older adults and those who are disabled also display signs of abuse.

Signs of an Abuser

Majority of people who experience sexual assault know their abuser. It is important to be on the lookout for common behaviors that abusers may have. Women can also be predators.

Adult – Child Abuse Signs

  • Does not respect boundaries or listen when someone tells them “no”
  • Engages in touching that a child or child’s parents/guardians have indicated is unwanted
  • Tries to be a child’s friend rather than filling an adult role in the child’s life
  • Does not seem to have age-appropriate relationships
  • Talks with children about their personal problems or relationships
  • Spends time alone with children outside of their role in the child’s life or makes up excuses to be alone with the child
  • Expresses unusual interest in child’s sexual development, such as commenting on sexual characteristics or sexualizing normal behaviors
  • Gives a child gifts without occasion or reason
  • Spends a lot of time with your child or another child you know
  • Restricts a child’s access to other adults

Adult – Adult Abuse Signs

  • Restraining partner against their will during sex
  • Acting out fantasies where the partner is helpless
  • Initiating sex when the partner is asleep
  • Demanding sex
  • Aggressive or violent
  • Isolates survivor
  • Emotionally volatile
  • Displays signs of jealousy
  • Controlling
  • Cruel to animals and children

Speaking Up and Seeking Help

Although less people are reporting their experience to police, more people are speaking up about what they’ve endured.

If you are a survivor of sexual assault, it’s never too late to speak up and share your story. It’s also never too late to get help.

  • Speak to someone you trust about what happened
  • Join a support group
  • Spend time with others
  • Find a counselor
  • Support other survivors


RAINN (Rape, Abuse & Incest National Network)

National Sexual Assault Hotline


Connects people to local resources

NSVRC (National Sexual Violence Resource Center)

Resources for survivors, family, and advocates

National Human Trafficking Hotline




Morgan, R., & Oudekerk, B. (2019). Criminal Victimazation 2018. Retrieved from https://www.bjs.gov/content/pub/pdf/cv18.pdf

Recent data from the Department of Justice


RAINN. (2019). Retrieved from https://www.rainn.org/SAAPM2019

RAINN. (2018). Retrieved from https://www.rainn.org/statistics/victims-sexual-violence

National Sexual Violence Resource Center. (2018). Retrieved from https://www.nsvrc.org/statistics

The Center for Public Integrity. (2018). Murdered and Missing Native American Women Challenge Police and Courts. Retrieved from https://publicintegrity.org/politics/murdered-and-missing-native-american-women-challenge-police-and-courts/#:~:text=More%20than%20half%20of%20Native,National%20Institute%20of%20Justice%20study

D.S. Riggs, T. Murdock, W. Walsh. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress 455-475

World Kidney Day

A few years ago, I noticed several dialysis centers popping up around Maryland and DC.  It seemed like there was one on almost every other corner. The amount of dialysis centers in my area has become so alarming that one of my former co-workers spoke about it during a meeting, as we tried to think of ways to focus more on chronic disease prevention than intervention and treatment.

I remember hearing about all my grandmother went through when she was on dialysis because of diabetes, but I had no idea just how many other people were impacted by kidney disease, especially around the world.

The Global Impact of Kidney Disease

  • Kidney disease is the 10th leading cause of death in the world.1
  • Majority of kidney disease patients are treated in the United States, Italy, Japan, Germany, and Brazil.2
  • Between 2005 – 2015, there was a 32% increase of the number of people who died from kidney disease.3
  • Roughly 5 to 10 million people die annually from kidney disease.3

Globally, the focus has been on providing access to prevention and treatment methods. However, a lack of resources, poorly equipped health facilities, and a lack of access to healthcare makes it hard for some to receive prevention education, medication, and treatment.

In the U.S., 37 million people are estimated to have kidney disease and 9 in 10 adults with kidney disease do not know they have it.4

The Function of the Kidney

The kidneys are two bean-shaped organs that are located on either side of the spine, behind the stomach. 5 The function of the kidneys is to remove waste and fluid from the body through urine, create hormones for blood pressure and blood cells, and regulate water, salt, and mineral levels so that the nerves, muscles, and tissues can work properly.6

Image from Cedars Sinai

What is Chronic Kidney Disease?

Chronic Kidney Disease (CKD) occurs when the kidneys do not function as they should, and toxins and extra water build up in the body.

The buildup of toxins and water can lead to other chronic health conditions, one being cardiovascular disease. The impact of untreated CKD can lead to kidney failure, which would require a patient to undergo dialysis or a kidney transplant. This late stage of kidney disease is known as end-stage renal disease (ESRD).7

Prevention and Management

A healthy diet, exercise, sleep, stress management, smoking cessation, limiting alcohol, we hear these prevention methods repeatedly, and they are the same for majority of illnesses. They are also the same for kidney disease. Practicing prevention methods can delay or prevent the onset of most chronic diseases, but what happens if you have CKD?

You can live well with kidney disease. Making lifestyle changes can help you manage the disease and live a long and productive life.

Ten ways to manage kidney disease

  1. Control your blood pressure
  2. Meet your blood glucose goal if you have diabetes
  3. Work with your health care team to monitor your kidney health
  4. Take medicines as prescribed
  5. Work with a dietitian to develop a meal plan
  6. Make physical activity part of your routine
  7. Aim for a healthy weight
  8. Get enough sleep
  9. Stop smoking
  10. Find healthy ways to cope with stress and depression

Source: National Institute of Diabetes and Digestive and Kidney Diseases (2016).

Thinking back to my co-workers comments, I now understand her frustration. Dialysis can be helpful, but remember that prevention is key, and making healthier choices, little by little, can help you live a long, productive, and healthy life.

Make sure you speak with your healthcare provider about your health concerns.

Image from worldkidneyday.org


World Kidney Day

National Kidney Foundation

National Institute of Diabetes and Digestive and Kidney Diseases


World Health Organization. (2020). The top 10 causes of death. Retrieved from https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.

National Kidney Foundation. (2020). Global Facts: About Kidney Disease. Retrieved from https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease.

World Health Organization. (2018). The global burden of kidney disease and the sustainable development goals. Retrieved from https://www.who.int/bulletin/volumes/96/6/17-206441/en/.  

Centers for Disease Control and Prevention. (2019). Chronic Kidney Disease in the United States, 2019. Retrieved from https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html.

Hoffman, M. (2019). Pictures of the Kidneys. Retrieved from https://www.webmd.com/kidney-stones/picture-of-the-kidneys#1.

National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Your Kidneys & How They Work. Retrieved from https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work.

Centers for Disease Control and Prevention. (2020). Chronic Kidney Disease Basics. Retrieved from https://www.cdc.gov/kidneydisease/basics.html#:~:text=If%20left%20untreated%2C%20CKD%20can,stage%20renal%20disease%20(ESRD).

Why I Wear Red

Early 2006, I received a call from my grandmother, whom we called Granny. She sounded out of it and wanted me to sit and pray with her. If you knew my Granny, you’d know that she was full of life, loved to keep busy, and kept a lot to herself because she didn’t like worrying others. Getting a call from her that she wasn’t feeling well was unusual. 

I recalled a couple of years prior when she was unable to attend my high school graduation because she wasn’t feeling well. I heard my parents and other family members talking about her health and even heard Granny telling someone about her acid reflux and how sick it would make her feel.  There were even days she would have to sleep sitting up to ease the pain.

After praying with Granny, we sat on her bed and talked. I wish I could recall what our conversation was about. All I can remember is the smile on her face. Granny was able to walk me to the door and see my off. She seemed better. Then November 10, 2007 happened.

“Cardiovascular disease (CVD) in women remains under-diagnosed and undertreated due to the diagnostic challenge it presents, as well as the persisting attitude that CVD predominantly affects men”1

Granny and 3 year old Me

I was unemployed and Granny was giving me tasks to do so that I could earn money. I arrived at her house early on November 10th to pick her up to grocery shop. When I arrived, Granny said that she didn’t feel up to going out but was still able to heat me up some oatmeal with applesauce. I asked her how she knew I loved eating my oatmeal with applesauce, she smiled and said that’s how she would make it for me when I was little.

After breakfast, Granny felt better and said that she would come to the store with me and grandpa. I asked her if I could interview her for my Africana Studies project and she said yes.  Then we left for the store.

Grandpa went into another store and Granny and I went into the Shoppers to pick up a few items. We started walking through the produce aisle when Granny took a diet Pepsi out of her purse. I had no idea what she was doing but remembered that she was probably drinking the soda to help with her acid reflux. Then she turned to me and said that she had to sit down.

We found a place for her to sit in the next aisle and she told me to get her antiacid medication. I ran to get the medication and when I returned, she had a look of agony on her face. Grandpa was standing next to her and the store’s manager asked if he should call 9-11. Granny said no and drank some of the antacid medication I found. Taking the medication only made things worse. She asked me to take her back home.

What we all thought was acid reflux wasn’t.  Granny didn’t show the signs and symptoms that I once heard about. Her hand wasn’t gripping her chest like Fred in Sanford and Son, she was able to speak… I had no idea that she was having a heart attack.

“She might not have the prototypical combination of features of chest pain, radiating pain down the arm, shortness of breath and sweating, which are often the examples given in textbooks.”2

Later that day, we were at the hospital and it was revealed that she had a massive heart attack. Not only that, but it was also told to the adults in the family that she’d been having mini heart attacks for some time. Her heart was severely damaged and if she were to make it, she would need care for the rest of her life.

Before leaving the hospital, she was able to give me a hug and whispered, “You always did take care of ol’ Granny,” into my ear. I thought everything would be okay. I didn’t know that would be the last time I would see her on earth. On November 13th, my Granny passed away.

“Heart disease is the leading cause of death for African American and white women in the United States.”3 

After my grandmother passed away, I began hearing news reports about women whose heart disease was misdiagnosed.  When compared to men, women are 50% more likely to be misdiagnosed.4 In a 2014 study conducted by the Women’s Health Alliance, only 40% of the women in the study had a heart health assessment during their annual wellness exam, and of the 75% who had a risk factor, only 16% were told that they were at risk for heart disease.5

Research has shown that women experience heart attack signs and symptoms differently than man. And although more men have heart attacks than women, women are more likely to die.

Today marks the 17th anniversary of Wear Red Day, which is celebrated the first Friday of February to bring awareness to heart disease. This Wear Red Day, I honor my fearless, strong, giving, kind, and most of all, loving Granny, Betty F. Massey.

For more information about heart disease, please visit heart.org.


Keteepe-Arachi, T. & Sharma, S. 2017. Cardiovascular Disease in Women: Understanding Symptoms and Risk Factors. European Cardiology Review. 12(1): 10–13. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206467/

American Heart Association News. 2020. Changing the way we view women’s heart attack symptoms. Retrieved from https://www.heart.org/en/news/2020/03/06/changing-the-way-we-view-womens-heart-attack-symptoms

Centers for Disease Control and Prevention. 2020. Women and Heart Disease. Retrieved from https://www.cdc.gov/heartdisease/women.htm

WebMD. 2018. Why Women Struggle to Get The Right Diagnosis. Retrieved from https://www.webmd.com/women/news/20180607/why-women-are-getting-misdiagnosed

Columbia Surgery. 2020. The Mounting Crisis in Women’s Heart Health. Retrieved from https://columbiasurgery.org/news/mounting-crisis-women-s-heart-health

Cervical Health Awareness Month

Exactly what is HPV? How often do I need a pap smear? What does a pap smear test for? What are the risk factors for cervical cancer?

After many conversations with women over the years, I’ve learned that vaginal health is something some of us know little about. We may not know all the parts and their functions, including the cervix which is located at the lower part of the uterus.  

One brilliant analogy is that of a hallway and door.  Picture the vagina as a hallway. At the end of the hallway is a door. The cervix is the door (Very Well Family, 2020), and includes the endocervix (the part of the cervix leading to the uterus) and the ectocervix (the outer part of the cervix that can be seen during vaginal exam).

What does the Cervix Do?

The cervix:

  • Protects the uterus by limiting access to foreign substances
  • Produces cervical mucus to clean the vagina
  •  Keeps the fetus in uterus

Do I need a Pap Smear and HPV Test?

Every 2-3 years, I make an appointment with my gynecologist for a pap smear. Do I like getting pap smears? Absolutely not. Getting pap smears is what I do to learn about my vaginal health.

Many of us are used to the procedure. It’s something I’ve mastered since getting my first pap smear when I was 21. I scoot up to the edge of the exam table as the nurse is handing my doctor the speculum, place my feet onto the stirrups, lie back, take a deep breath, and look up at the ceiling as my doctor carries out the exam.

It is recommended that women get pap smears every 3 years, beginning at the age of 21.

A pap smear/pap test is used to detect vaginal abnormalities. It’s important to note that a pap test is different from a human papillomavirus (HPV) test. The pap test is used to detect abnormal cells and an HPV test is used to detect HPV, a virus which increases a woman’s risk of developing cervical cancer. Most forms of cervical cancer are caused by HPV. Although both tests are different, a pap test sample can be used to test for HPV.

Image from Pinterest

Cervical Cancer

Once the leading cause of cancer death for women in the United States, the rate of cervical cancer, and cervical cancer deaths, have drastically decreased (Centers for Disease Control and Prevention, 2020).

This year, roughly 13,500 women will be diagnosed with cervical cancer, and over 4,000 may die from the disease. Cervical cancer is mostly diagnosed in women ages 35 to 44. However, older adult women are also at risk.  Twenty percent of cervical cancer is detected in women over 65 years of age (American Cancer Society, 2020).

Image from Singing River Health System

What are the risk factors?

  • HPV Infection
  • Sexual history (increases exposure to HPV)
    • Being sexually active at a young age
    • Having multiple partners
  • Smoking
  • A weakened immune system
  • Chlamydia infection
  • Long-term use of birth control
  • Economic status
  •  A diet low in fruits and vegetables
  • Family history

Source: American Cancer Society, 2020.


Smoking increases the risk of cancer development. Smoking cessation can reduce a person’s risk of developing any type of cancer.

Having multiple sexual partners can put someone at risk of acquiring HPV. Women with multiple sexual partners are at risk of developing cervical cancer especially if they have sex with high-risk partners.

HPV vaccines prevent certain types of HPV, which can cause cancer. Children and young adults can get vaccinated, but it is not recommended for someone older than 26.

Although a condom may provide some protection, it may not prevent HPV.

Early detection is key. Pap smears and HPV tests are forms of early detection and can save lives. Make sure you speak with your healthcare provider about your cervical cancer risks and get tested.


Centers for Disease Control and Prevention. 2020. Cervical Cancer Statistics. Retrieved from https://www.cdc.gov/cancer/cervical/statistics/index.htm

American Cancer Society. 2020. Key Statistics for Cervical Cancer. Retrieved from https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html

World AIDS Day

December 1st is World AIDS Day. There are many health topics that I teach on, but this topic is one that’s close to my heart.

Instead of giving the basics of HIV/AIDS, I’ve decided to use this post to share personal stories of HIV/AIDS from my point of view as a woman, as a former HIV tester and counselor, and as a community member/loved one.

Getting Tested

“Do you want to be tested for HIV?” Whenever I’m asked that question, I say yes without hesitation, but inside my heart starts racing and I think back to the times I was foolishly “in love” and didn’t practice what I preached.

I have my blood drawn and wait for my lab results to be posted, constantly checking to see what the results will be. Contracting an STD when I was younger puts me on the edge, especially knowing that having an STD put me at a higher risk of contracting HIV. I think back to when I last had an HIV test and the last time I was sexually active before deciding to practice abstinence. I tell myself that I’m okay. I tell myself that everything will be fine.

After 1 – 2 days, I get my test results back… “negative.” I’m relieved, and forgive myself again for not asking my previous partners questions. Monogamous on my end, but not on theirs. This is the reason why I tell others to get tested even if they are in a monogamous relationship… even if they’re married.

Get tested, even in a monogamous relationship. Married? Still get tested!

Being an HIV Counselor

“You are not going to actually test your partner for HIV, you are only going to practice the steps for doing an HIV test. Someone who was tested in class found out that they were HIV positive. We don’t want that to happen here.” To get my HIV Tester and Linkage to Care certification, I was required to complete a course that would help prepare me for the real world of HIV testing.

For reasons I’m still trying to figure out, I’ve been drawn back into the field of HIV/AIDS time and time again. Throughout different seasons of my life, I’ve taught about practicing abstinence and safe sex, but actually conducting HIV tests would be something completely new to me; and after hearing my trainer tell the story of how one student found out that she was positive during a training, I wondered how I would tell someone that they were positive and how they would react in return.

“Tonja, look at this.” I walked over to my co-worker and looked at the rapid HIV test she just ran. “He was here a few weeks ago and was negative. He told me he isn’t sexually active.” She ran his test again to make sure it wasn’t a false positive. The results were the same.

I stood near as my co-worker explained the results to the older adult sitting across from her. He looked confused. She filled out the rest of his paperwork, explained the test was showing that he was positive for HIV and someone would reach out to him.

I tested people time and time again without having to break the news to anyone that they were positive. I wondered what this older gentleman was thinking when he heard, “HIV positive.” Weeks prior, I was speaking to him and his buddy, telling them that older adults are at risk of getting HIV. That even if they didn’t have to worry about getting anyone pregnant, they still had to think about STDs. I stood there wishing there was something I could do as he quietly walked away.

“According to the Centers for Disease Control and Prevention (CDC), in 2016, nearly half of the people in the United States living with diagnosed HIV were aged 50 and older. Many HIV risk factors are the same for people of any age, but older people are less likely to get tested for HIV.”

National Institutes of Health, 2020

Having an HIV Positive Community Member/Loved One

“Aren’t you afraid?” Someone once asked me when I told them that I’ve worked with people with HIV/AIDS. Am I mindful when testing or if someone has an open wound? Yes, but not afraid. I’ve embraced and been embraced by those with HIV & AIDS. We’ve shared laughs and stories.

A few months ago, I wondered how my Mamas at Lifted Strong were doing. I spent an incredible week with them last summer as I volunteered as an HIV Support Worker for the organization. I went to their Instagram page which led me to the managers page, it was there that I found out that Mama Anna had passed away. I thought back to the brief moments we spent together, and the laughs we shared as she tried to interpret my version of Kisawhili.

This wasn’t the first time I’ve met or known someone who has passed away from complications due to AIDS. Years prior, I learned that a member of my Peace Corps mentor’s People Living with HIV/AIDS group had also passed away. Then weeks later learned that the Peace Corps staff member who shared her story with volunteers had also passed away. As she told her story, I thought about how strong she looked. Even before Peace Corps, AIDS hit close to home. I overheard my mother discussing an old family friend’s diagnosis and how he died because of complications related to AIDS.

Whenever I think of those I’ve encountered with HIV/AIDS, those who have shared their stories, and even those I’ve tested who were relieved when they received a negative test result, I am reminded to appreciate the life that I was given, to love hard, to educate others, and to make better choices.

This post is to honor those who share their experiences to educate and support others. And to honor the Annas of this world. Those who fought as long as they could but lost their life to the disease.

Contact your doctor or local health department to learn about HIV testing in your area.

For more information on HIV/AIDS, visit WHO and UNAIDS.


AIDS Healthcare Foundation – Provides HIV & STD testing

National Association of County and City Health Officials – Health department directory

HIV.gov – Information on HIV/AIDS

Diabetes and the Importance of Knowing Your ABCs

Every part of our health is intertwined. Our blood pressure, blood glucose, and cholesterol are interconnected, and an issue with one of those may lead to an issue with another.

For example, someone with diabetes is more likely to have hypertension (high blood pressure). They are also more likely to have high cholesterol leading to coronary artery disease (CAD) and other comorbidities (having two chronic diseases at once). This is why people with diabetes should know their ABCs.

What are the ABCs?


A1C is your estimated average blood glucose level over a three month time span. Unlike the normal blood glucose test, the A1C provides an in-depth look at your blood sugar levels.

  • An A1C below 5.7% is normal
  • An A1C between 5.7% to 6.4% is within the prediabetes range
  • An A1C above 6.5% or higher is within the diabetes range

Lifestyle changes can improve blood glucose levels. Read a personal story here.

BBlood Pressure

Two out of three people with diabetes have high blood pressure.1 When your heart beats, blood moves through your body providing blood and oxygen throughout. When someone has high blood pressure, blood vessels can become constricted, limiting the flow of blood and oxygen.

The general goal is for your blood pressure to be less than 120/80. However, if you have high blood pressure, your blood pressure goal may be different. For example, if your blood pressure is normally above 140/90, your goal may be to bring your numbers down to 130/80.

It is possible for someone with hypertension to bring their numbers down to less than 120/80.


Cholesterol is a waxy substance naturally produced in the liver. It is also found in animal based products, and is needed to make hormones and is used for food digestion.

There are two types of cholesterol. LDL (low-density lipoproteins) is the bad cholesterol and HDL (high-density lipoproteins) is the good cholesterol. LDL increases the risk of heart disease and plaque buildup. HDL carries cholesterol to the liver so it can be removed from the body.

Triglycerides are a type of fat that can cause a blockage in an artery if LDL levels are high and HDL levels are low. A diet that increases HDL and lowers LDL can protect your heart health.

Make sure you know your numbers and make healthy choices to prevent and manage diabetes.


American Diabetes Association. (2020). Conquer High Blood Pressure. Retrieved from https://www.diabetes.org/diabetes-risk/prevention/high-blood-pressure.

American Diabetes Association. (2017). HDL (Good), LDL (Bad) Cholesterol and Triglycerides. Retrieved from https://www.heart.org/en/health-topics/cholesterol/hdl-good-ldl-bad-cholesterol-and-triglycerides.

Hypoglycemia and The 15-15 Rule

Hyperglycemia (high blood sugar) is caused when there is a build up of glucose (sugar) in the blood. People with diabetes can experience hyperglycemia if they are unable to manage their diabetes; causing frequent urination, increased thirst, and high levels of sugar in their urine.

Hypoglycemia (low blood sugar) is another term that people, diabetics in particular, should know. Blood sugar falling below the target range (see National Diabetes Month) can lead to insulin shock or even death.

Signs and Symptoms of Hypoglycemia

  • Shakiness
  • Weak and lethargic
  • Headache
  • Nausea
  • Lightheaded or dizziness
  • Blurred vision
  • Hunger
  • Tingling or numbness
  • Racing heart
  • Confusion
  • Sleepiness

Treating hypoglycemia

The 15-15 Rule is a method used to treat hypoglycemia without spiking blood sugar. It consists of consuming 15 grams of carbohydrates then waiting 15 minutes before checking to see if your blood sugar is above 70 mg/dL.

What can you take?

  • Hard candy (read the label)
  • Tablespoon of honey
  • 4 ounces (1/2 cup) of juice
  • 4 glucose tablets
  • Gel tube
  • 4 ounces (1/2 cup) of regular (non-diet) soda
  • 8 ounces (1 cup) of milk

If your blood sugar is still below 70 mg/dL after following the 15-15 Rule, repeat again. Once your blood sugar is above 70 mg/dL, you should eat a small meal or snack.

Keep track of your blood sugar by using an App or printable tracker.


American Diabetes Association. (2020). Hypoglycemia (low blood sugar). Retrieved from https://www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/hypoglycemia.

Picture by Andrea Piacquadio from Pexels

National Diabetes Month

I remember watching my maternal grandpa slowly fill up a syringe and inject medicine (insulin) into his stomach. Sometimes, I would hold the side of his stomach so that he could administer his medicine. Grandpa would do the same with each of his grandchildren, walking them through the steps of injecting insulin and taking his blood glucose readings.

Although he had diabetes, which runs in his family, Grandpa learned as much as he could and took steps to manage it. He enjoyed exercising, would go to his appointments regularly, checked his blood sugar throughout the day, and ate a balanced diet, which would include an occasional small scoop of butter pecan ice cream when he wanted to indulge.

Grandpa: Curtis Massey & Memaw: Guinevere Rice

On the other end of diabetes self-care spectrum, I remember the latter years of my paternal grandmother’s life. I remember walking into Memaw’s room at a nursing home in complete shock because both of her legs had been amputated, and there were dark boils on her body. She laid there in agony. Her complexion, which was once light, was now darker and ashen.

The same grandmother whose smile could brighten up a room was losing her battle to diabetes. Life happens to everyone, but I believe the hardships of her life overshadowed her being able to manage her diabetes. She couldn’t properly care for herself and succumbed to the disease.

Growing up, I only thought of diabetes as “the sugar disease.” I thought that if I limited how much sugar I ate; I would be okay. I had no idea that my health was at risk because diabetes runs on both sides of my family. I had no idea what insulin was, that there are different types of diabetes, or ways other than diet that could prevent me from getting it.

Thankfully, I don’t have diabetes nor am I prediabetic. Having diabetes run on both sides of my family has made pay attention to any changes in my body. It has also motivated me to keep track of all of my lab reports for over the past ten years.  It’s hard, even as a health educator, but I try my best to focus on what I have control over (i.e., nutrition, exercise, stress management, sleep hygiene, etc.) to keep my blood glucose number down. I also enjoy being able to share my personal experiences, knowing and working with people who have diabetes, to educate others.  This post is simply that, a means to provide basic diabetes education.

What is diabetes?

If someone were to ask you what diabetes is, what would you say? I can recall the responses from people in my Diabetes Mapping classes. While they had diabetes, some of them didn’t understand what it is. Let me break it down as much as possible.

Diabetes is a group of diseases that is caused by a build up of sugar in the blood stream causing hyperglycemia (high blood sugar).

Let’s say that you eat a slice of pizza. That slice of pizza is broken down into sugar when it enters your body and then the sugar enters your blood stream.  If the sugar from the food you eat builds up in your bloodstream, your nerves, blood vessels, organs, and other parts of your body can be damaged.

What causes the build up?

Insulin is a hormone produced in the pancreas; it is known as the key in diabetes terminology because it unlocks cells so that blood sugar (glucose) can enter. Some people may not make insulin or enough insulin, while some make insulin that does not work properly. If insulin does not unlock cells for blood sugar to enter, the sugar begins to build up in the blood stream.

Glucose is needed because it provides the body with energy and supports cells, muscles, and organs like the brain. But be careful, too much glucose can harm the body.

Image from Health Interactions

The three types of diabetes

There are three types of diabetes: type 1, type 2, and gestational. Prediabetes is not diabetes, but it is a diagnosis if someone has a high risk of developing diabetes because of their A1C (2-3-month blood sugar reading).

Type 1 Diabetes

Type 1 diabetes, also referred to as juvenile diabetes, occurs when a person’s immune system attacks cells in the pancreas that make insulin. Because the pancreas is attacked, it either does not make insulin OR it does not make enough.  

This type of diabetes normally occurs in childhood but anyone of any age can have it.

Type 2 Diabetes

Type 2 diabetes is the most common type of diabetes where the body does not use insulin properly leading to insulin resistance.

Image from Nuvo Vivo

Gestational Diabetes

Gestational diabetes occurs when a pregnant woman has a build up of glucose in her bloodstream. Pregnant women are normally tested for diabetes between their 24th – 28th week of pregnancy.

Having gestational diabetes can put a woman at risk for developing type 2 diabetes.


Prediabetes is not diabetes. Being diagnosed with prediabetes means that you are on the verge of developing diabetes. However, weight loss, exercise, and a change in other lifestyle factors can prevent you from becoming diabetic. 

Personal Story: Someone who joined one of my 8-week health classes started off prediabetic. He joined the class because the doctor told him to lose a few pounds because of his diagnosis.  After losing 20 pounds and making major changes to his diet and exercise routine, he received news that he was no longer prediabetic!

Knowing your numbers

A person’s blood sugar reading depends on their health, if they have diabetes, their activity level, what they eat and when they eat. Have you noticed that you’re asked not to eat or drink anything besides water before a physical? That’s because of blood work that is done to check your blood sugar/A1C. Below are the blood glucose and A1C ranges. It’s important to keep your blood glucose reading within a healthy range and keep track of changes in your blood sugar results as you age.

Prevention and Management

A family history, race/ethnicity, and age are factors that we have no control over. But diabetes can be prevented and managed through:

Image by Breakingpic from Pexels
  • Weight loss – Losing 10% of your body weight can help prevent and manage diabetes.
  • Nutrition – Following a diet low in sodium, saturated and trans fats, simple carbohydrates (i.e., white grains, pasta, honey, milk) and high in vegetables, lean protein, fruit (too much fruit can be bad for a diabetic) and complex carbohydrates (i.e., whole grains) may prevent and manage diabetes.  Diabetics should “test” how their body responds do certain foods by checking their blood glucose 2 hours after eating.
  • Exercise – Exercising moves glucose into muscles, moving it from the blood stream. Diabetics should have an exercise routine that will help them manage their diabetes without causing hypoglycemia (low blood sugar – not enough blood sugar).
  • Sleep hygiene – Getting restorative sleep (all stages, specifically 3 &4) regulates blood sugar and heals the body.
  • Stress management – Practicing stress management techniques can lower blood pressure and improve blood glucose.
  • Medication management – Taking medications as prescribed is one of the most important ways to manage diabetes.
  • Glucose numbers – Knowing your blood sugar range/A1C is the first step to prevention and management of diabetes.

To learn more about diabetes, visit the American Diabetes Association website and speak with your healthcare team about your concerns.

Breast Cancer Awareness Month in Ghana

Mary and Tonja

As soon as the boarders were open, I decided to go on an overdue trip to provide health education and outreach in Ghana. While there, I met a young lady, Mary, who was excited to share with me what she recently learned at her church’s Breast Cancer Awareness Month event.

Mary and I discussed risk factors, signs and symptoms, how to do a self-breast exam, and what she learned about breast cancer in the United States. Because I wanted to learn specifically about breast cancer in Ghana, I decided to ask Mary a few questions.

Tonja: What did you learn about breast cancer here in Ghana?

Mary: Breast cancer in Ghana has increased every year.  The last two years, it has increased. But, if a woman has a lump and it is detected early, the cancer can be removed, so that she can be free from cancer.

Tonja: Do women here go to the doctor to get a breast exam every year?

Mary: You know…in Ghana, most people feel shy to go to the doctor, or maybe they don’t go because of low income.  They may be afraid that if they go to the doctors, they’ll be charged and not have the money for it.  They may think, “Why would I force myself to go to the doctors without having money,” so they don’t go.  Those who have money in big cities like Accra, Kumasi, Cape Coast, they may pay and have health exams. Those who have family that work at health facilities may also get checked.

Tonja: Do you think there is anything that can be done to make people feel less afraid or shy of getting a breast exam?

Mary: If someone has a family member that works at the doctor, and they are diagnosed, they may be afraid that the news will spread. If possible, avoid going to a doctor where you have a family member or know someone.

Tonja: Do you think the stigma of breast cancer is just as bad as having HIV?

Mary: Yes. For example, if you have breast cancer and have to have your breast removed, people may stare and talk because it is different. We don’t really see that. People will talk.

Tonja: What do you think can be done for more women to get checked and decrease stigma?

Mary: I think more breast cancer awareness. It gives women education and information about breast cancer and helps them to know they can get help. Women can also get to know that they need to have their breast checked each year.

One thing that I’ve learned about being in Ghana is how many people view food as medicine.  Mary also learned about the benefits of eating a variety of local fruits and vegetables to lower a person’s risk of developing breast cancer. 

Like many others, Mary believes in the benefits of eating a variety of fruits and vegetables to prevent some cancers.
Sour Sop, also known as “Sweet Apple,” is recommended for cancer prevention in Ghana

Fast Facts about Breast Cancer in Ghana

  • Breast cancer is the most common type of cancer in Sub-Saharan Africa
  • Breast cancer is diagnosed at early ages across Africa than on other continents
  • The highest incidence rates of breast cancer in Ghana is for women ages 40 to 46
  • Forty-seven to 57% of breast cancer cases in Ghana are women diagnosed under 50 years of age

Source: Iddrisu, M., Aziato, L. & Dedey, F. Psychological and physical effects of breast cancer diagnosis and treatment on young Ghanaian women: a qualitative study. BMC Psychiatry 20, 353 (2020). https://doi.org/10.1186/s12888-020-02760-4

Because of health observances like Breast Cancer Awareness Month, people all over the world are seeking knowledge, gaining knowledge, and making small changes; and in my opinion, combating stigma little by little.