The Tema Market

A few weeks ago, I was in desperate need of some vegetables and spices, so Dennis said we could get both at the Tema market for a lot cheaper than you can find in a grocery store. I said sounds good. I’m not really sure what I was expecting the Tema market to be, but it turned out to be quite the adventure.

We came upon a narrow street lined with booths, cars parked on both sides, so that only pedestrian traffic could pass. Behind the booths was a very high cement wall, large enough to not be able to see what lay behind. Dennis pulled up behind a car on the right-hand side of the street and said “We’re here. Let’s go.” The first thing I saw was a large cage filled live chickens, and Dennis informed me that for 10 cedis (like $7), they would kill one, de-feather and dress it for you. He said that for 12 cedis you could get a “free range” one, motioning to the group of chickens running around on the side of the road. Next to the cage was a van parked so that the rear opened up onto the street, its back doors open wide with a few guys sitting in the back, legs dangling. When we got close enough to the van see what was inside, it was eggs: hundreds of eggs in cartons stacked the height of it. We kept walking along to see several booths of vendors of all kinds: clothing, food, cosmetics, etc. We came across a vegetable seller, and Dennis let me look at some tomatoes and onions for a few seconds, before saying “Let’s keep going.” I looked up and down the street, as well as the adjacent booth-lined street and asked “How much more is there?” Dennis just laughed and said “You’ll see.”

When we got to the end of the street we were on, we hung a right onto a street even more populated with booths and people. The high wall ran along this street as well. The further we walked the more dense everything became. I could see up ahead that everyone was filtering through a gate on the right that led into the space behind the wall, and when we got there, my jaw definitely dropped. What I thought was the market was the bare outskirts, and the true market lay in every inch of the plaza enclosed by the high walls, where hundreds of booths manned by haggling vendors were pressed together to allow no more room between them than was needed to walk. I though immediately of two things: my good friend (who shall remain nameless) that is diagnosed with ADD (true ADD, not a function of the over-prescribing, drugged-up society we live in today), who would have loved every second of all the activity, vibrant colors and noises of the market, and a favorite childhood movie called “Bed Knobs and Broomsticks” in which Angela Lansbury sings a song called “Portobello Road” about a street in London where you can buy “anything and everything a chap can unload.” The Tema market was a lot brighter and less dusty than the road protrayed in the movie, but I can’t really help the linkages made by my mind sometimes. I also couldn’t really decide what to look at and in what order: a basket full of shimmering blue crabs or a table covered with giant African snails bigger than your fist (a delicacy, according to Dennis). We approached the most colorful table in sight which boasted a rainbow assortment of tiny bags of spices. I bought some garlic, curry (good curry that actually has some zing, not the weak stuff you find in America and have to resort to the paste) and chili, but was denied cumin and basil (partly because Dennis didn’t know the Twi translation and partly because they actually might not grow those here and I have to settle for imports).

shot of the market right at the entrance...booths as far as the eye can see.

shot of it a little further in. You can see plantains and yams on the front table.

giant African snails...DE-licious.

We actually didn’t stay long to peruse. Being the guys that we were, our shopping entailed knowing exactly what we needed to get, getting those things, and then leaving; we were not hampered by a second X chromosome, which necessitates window shopping. I would go on to buy some tomatoes, onions and peppers, along with a dozen eggs from the dudes in the van and a whole smoked mackerel. Making our way back to the gate to leave, Dennis and I were stopped by a shady guy carrying a basket full of what turned out to be blister packs of medicines. As politely as possible, Dennis told him that he was a registered pharmacist, what he was doing was illegal, and that if he ever saw him again, he would call the police. (I’ll leave the health schpiel out of this entry, but you do not want to get me started about antibiotic resistance. Needless to say, that was not cool, and it brought my nice little trip to the market back down to reality very quickly.)

platter full of smoked mackerel. I chose the most delicious one.

When we got back to the car, I opened the trunk to deposit my spices, veggies, eggs and fish, and I looked over at the chicken coop close by. As much as I wanted a chicken to be slaughtered all because of my appetite, I couldn’t bring myself to do it. Maybe next time, I told Dennis, because I really want to come back as much as possible. The market is only open on weekends, and I could probably come back every Saturday until I leave and not see everything there is to see in there. That night I de-scaled and de-boned the mackerel all by myself and made a deliciously spicy fish curry…with a little garlic: BAM!

A Night Out on Oxford Street

In a previous entry, I delved into my lack of both a social life so far in Accra, as well as interactions with other obrofo (white people). As I had also mentioned, I was invited to dinner a little bit ago on Oxford Street (the ex-pat/aid worker area) with two (white) guys around my age working for the Clinton Foundation, one of whom I had met at a conference. So, I would like to take this opportunity to tell you a little about that night.

Allan, the guy who invited me, and I had actually communicated previously (via phone and email), when I was exploring my options for working abroad. I still had no idea what he looked like, let alone that he was in Accra. So, to say that I was surprised (or that it is a small world) when we met in person, is an understatement. Allan was to meet a colleague for dinner on Saturday night at 7pm, at a sushi restaurant called Monsoon on Oxford Street, and he asked me if I’d like to join. I tried not to be too excited when I said sure, but the prospect of having a social engagement for the first time in a long time, let alone with two other white guys close to my age, was a nice feeling. It was like a guys night out.

That was the extent of my knowledge about dinner. According to my trusty Ghana/Accra tourist book and pull-out map, Oxford Street was the center of a very happenin’ upscale neighborhood called Osu with some of the best shopping, restaurants and night life in the city. I was also able to see that the street was about 1 mile long, located in the southeastern part of the downtown area. As the crow flies, it looked to be about 10km (6 miles) from where we lived northeast of downtown, but in terms of navigable roads, it was more like 15 (9.5 miles). So, I needed to consult with Dennis about my transportation game plan.

He told me that from where we lived, and how cabbies’ rates worked, it would be cheaper to take three group cabs from where we lived: the first one straight west to a high-traffic spot, the second one straight south into the city to another popular junction, and then the third one to my destination. He explained that with cabs, you have two options: group and individual. The color of my skin being what it is, he said cabs would automatically assume I wanted an individual ride, so I had to insist it was group. Group meant that they would pick up other passengers on the way, and it would be a fraction of the price. As I was completely deferring to him on this one, I said group cabs were fine with me and agreed to do whatever he thought was best.

So, at 5pm on Saturday night (I was giving myself plenty of time for a worst-case/ getting lost scenario), armed with map and camera, Dennis drives me to the main drag where I would catch the cab. Right when we get there, one of those “private “vans I previously mentioned (It is a conversion van that seats about 16 comfortably and commonly squeezes in 20. Run by a driver and a door guy/cash man, they run specific routes to fill the gap for the lack of public transportation, and are a very big private transportation enterprise in Accra.) skreeches to the curb, and several things happen at once: Dennis shoots me a quick glance, says that it will be a lot cheaper than a group cab and I can take the same 3-stop route we mapped out, I shrug my shoulders to tacitly say “Sure, what the heck”, he negotiates the fair (75 pesues = 55 cents) and the door guy gently shoves me into the front row of seats behind the driver and next to woman cradling an infant.

a typical private van

It becomes immediately clear that this is a very smoothly-run operation. The driver is the most aggressive on the road, swerving in and out of traffic, on and off the actual road, while the cash man hangs out the door yelling the final destination of the van for those on the side of the road who might want to get in. Sometimes the door is closed and the cash guy hangs out the open window, but most of the time he keeps it open for ease of exit and entry. At each stop, he gently pushes some on and some off, continuously haggling fares with multiple potential riders, never forgetting to yell the van’s destination (Accra Mall) less than 100 times a minute. When the van pulls away from a particularly busy stop, he closes the door and turns his attention to the riders inside, snapping and pointing to collect the agreed-upon fare and dole out the correct change. It is a well-oiled machine, to say the least.

As the day turns to night, the traffic into the city gets worse, and the exhaust from all the vehicles that floats in through the windows causes many to cough. The heat, however, makes closing them a non-option. Halfway to the mall, the baby next to me starts screaming, and the woman quickly pulls out her bosom to feed. Baby stops crying. No big deal. I exit at the mall with many others and have to cross a highway of sorts to get to where I want to catch another van going south. After waiting for a lull in the speeding cars, I am able to cross and another van pulls up in no time. “How much to Sankara?” “40.” “30.” “Fine.” It seems silly to be haggling over paying 35 cents or 25 cents, but for Ghanaians it would be silly not to. Plus, it is fun and gets people smiling.

This time I am in the back row, next to two police officers with AK-47s. Thankfully it is not as crowded, and then guns are able to have their own seat. At this point I am into unknown territory, and I continuously steal furtive glances at my map, which I have folded many time to make as small as possible. Hospital should be coming up on the right…there it is…good, not lost yet. I get out at my next stop, look at my watch (5:45) and my map: Oxford Street looks to be only about ½ a mile away. Pretty happy with myself that I just paid about 75 cents to go about 10 miles in 45 minutes, I start walking. About halfway to the top of Oxford Street, I see a big white building across the street on the left, and notice the sign “UN Headquarters”. I never really stopped to think about why this area had become the pale-skinned haunting grounds, but then the fog lifts and it all makes sense.

UN Headquarters in Accra

At the top of Oxford Street, I see two big groups of signs for some of the things I can expect to find. The sun has completely set, as I turn the corner. In a word, the street is busy. It’s one lane each way, with a good amount of traffic. Vendors of purses and soccer jerseys and food hug the road, backlit by the neon signs from the buildings behind them. Bank, restaurant, clothing store, bank, restaurant, bar, bank, clothing store, bar: I am seeing a pattern. It is very clear that this is the North Michigan Avenue, the Georgetown (M Street), the Newberry Street of Accra. After about 5 minutes of walking and getting heckled by salesmen, I come across the huge neon blue letters of Monsoon. Next to it is a sign declaring: “Now Open: Sushi, Pan-Asian, Seafood and Steak.” I call Allen to let him know that I am quite early. He has some “conference calls with Vancouver” to take care of, so I tell him no big deal, I can certainly entertain myself for an hour. He says “You gotta at least go to Frankie’s, and I’ll see you at 7.” Having no clue what Frankie’s is, I agree.

maybe 1/3 of the signs at the top of Oxford Street

Wrangler store on Oxford Street....supposedly "The Authentic Western Jeans"

A little further on, I see exactly what Frankie’s is: an oasis is the desert. A bakery and Gelateria. People sit on stools and chairs on the outdoor patio, licking and crunching and biting happily. Cool air conditioning blasts me in the face, as I open the door and try my best to close my jaw. Glass display cases boast shelves of sugar coated pastries on top of loaves of fluffy and crusty breads, reminding me of Paris. And then of course there is the gelato, bringing back memories of Italy. I might have shed tears, I’m not sure. Dinner is in less than an hour, but this is GELATO! I don’t even look at the price before ordering two scoops (espresso and cookies n’ cream). It could have been $20, and I would have paid gladly. It happens to be 3 cedis (about $2.25), and it is delicious. Not Rome delicious, but North End of Boston delicious. I deliriously walk outside with cup and spoon in hand. The heat melts it quickly, so I am forced to inhale it, as I actually tend to do with desserts anyways.

croissants, muffins and other European-influenced pastries

GELATO!

I still have about 30 minutes to kill, and knowing that the Chelsea vs. Man City game is on, I find a little bar to grab a Ghanaian Guinness and watch. (Guinness has a brewery in Ghana, where it manufacturers a beer called “Guinness Foreign Extra”. More alcoholic than the regular stout (over 7%), it looks and tastes like a regular Guinness on first impression, but the finish is a lot more hoppy and bitter than the smooth stout you find in the US. It is a great combination and VERY good.) The beer is a little more than $1 (dangerous), and I go outside to where a dozen guys sit on plastic chairs surrounding a TV. The score is 1-1, as the second half is just starting. I talk soccer with some of the guys, and sip on my beer. In general, most Ghanaians love Chelsea, because their countryman and most-famous Ghanaian soccer star in the world, Michael Essien, plays for them. So, 10 minutes after I sit down, when the star of Man(chester) City – Argentenian Carlos Tevez – scores a fantastic goal on a free kick from 30 yards out he puts UNDER the wall and inside the far post to take a 2-1 lead, they are not too happy. I stay as long as I can, but am forced to leave for dinner in the 70th minute.

random shot of Oxford Street

As I walk into Monsoon, I get a call from Allen that he is running late, but that his friend, Isaac, should be there. I spot a 20-something guy at the bar, with a Katrina Relief t-shirt on and ask him if he is Isaac. He is, and we get to talking. He works for the Clinton Foundation at their West African HQ in Lome, the capital of neighboring Togo. He is here only for the night, catching a flight out for the US in the morning. We order drinks and get to talking. He is from Belmont, Massachusetts, a stone’s throw from Tufts, went to Brown and starting volunteering for the Foundation after college. Allen shows up and we get a table.

The place is a swanky rooftop, very big with several bars, big bay windows overlooking the street, arched doorways and a very Mediterranean feel, like something you would find in Casablanca. Non-Africans of all kinds are everywhere, and I am a little overwhelmed. Moustached, pot-bellied Middle-Eastern business types stereotypically smoke cigars at a table with their much younger, skinnier female counterparts. At the next table, a group of overdressed girls sit, and Allen makes a comment about regretting not wearing his glasses. Couples are everywhere.

Allen, an Accenture-trained business consultant type from Vancouver says that it’s the best sushi he’s found in Africa, and being from Vancouver makes his somewhat of an expert. One look at the menu tells me I am going to spend more tonight than I did all last week. With a decidedly why-not attitude, I join them in ordering bowls of noodles and sides of sushi, as we discuss our common experiences. Allen’s craziest stories come from time he spent in Nigeria, and Isaac talks about life in francophone Lome, with a Togolese girlfriend he has acquired. I find it surprisingly refreshing and fun to share stories, commiserating about African frustrations and acknowledging African virtues. Dinner takes quite a while, but time goes quickly. The noodles I could make better myself, but the sushi is truly good. Before we know it, it is 9:30 and we are asking for the check. Allen has to go back to his place to do some work, but Isaac and I decide to go to a bar for bit.

We hop in a cab to an ex-pat bar Allen tells us he has heard is good, but after deciding to not pay the 15 cedi ($10-12) cover charge, we end up back where we started. Isaac asks me if I like to smoke hookah. “If been known to from time to time” I say. He says his hotel is a few doors down from Monsoon, and there is a good hookah bar in the lobby. “Let’s do it” says I, so we do. (Sorry mom and dad, but I didn’t inhale). It turns out to be quite fun, and we chat some more, unsuccessfully playing the college “Do you know…” name game, as we smoke apple-flavored shisha. Before I know it, it is going on midnight, and I have a lot longer to travel. Wishing Isaac a safe flight and exchanging contact info for when he is back in town, I bid him adieux.

This entry has been long enough, so I will wrap it up. Needless to say, the vans do not run that late at night, so I have to spend 10x as much money to get home as I did to get there. As I lay down to sleep, I feel quite satisfied with the night: gelato, Guinness, sushi, hookah, and new friends. I can’t have nights like that all the time, as I had spent a non-negligible fraction of my monthly budget in one night, but every once in a while, it’s fun to let loose.

Throwing Coke Bottles at BRICS

When you work in the global health field long enough, specifically when you work with groups that advocate for increased “resources” (dollar dollar bills) for R&D (research and development) for new products (drugs, vaccines, and diagnostics) targeting “diseases of the developing world” (mostly HIV, Tuberculosis, and malaria) long enough, and you attend enough meetings and conferences around Washington, DC to last a lifetime, you will undoubtedly hear about the Coca Cola Syndrome. The Coca Cola Syndrome, when discussed in this context, refers to the fact that the Coca Cola Company has MUCH better supply chain management than pretty much any resource-poor country’s health system this world over. What this means is that you can go to the most remote, rural villages in the world and find people drinking Coke, but we are utterly unable to get the health care products most needed by those same people into their hands. This subject is almost always broached by someone opposed to giving the R&D folks more money: someone who then advocates that the money would be better spent strengthening the supply chain on the ground and enabling the products that we already have to reach the people who need them. If the naysayer feels exceptionally clever, he/she might even tell another little anecdote about warehouses full of medicines and vaccines that have wasted away and become useless over months and even years of neglect: more victims of the African or Asian or Latin American sun. But this entry is not intended to weigh the merits of the new products vs. supply chain debate; the truth is that both things are greatly needed. No, I would like to get back to the ever-present Coke.

one of thousands of roadside shops always stocked with Coca Cola

Many of you have asked me what the food is like. I have detailed a few dishes in previous entries, but if I had to describe Ghanaian food in one word, it would be “unhealthy.” For breakfast every morning we have what’s called “Hausa Cocoa”. It’s a delicious porridge-like drink made from ground millet and spices originally from Nigeria, which has now become engrained in Ghanaian culture as well; but that’s not what is unhealthy. It is served with fist-sized fried doughnut balls and other smaller fried morsels made from chickpeas. Dennis reminds me that the chickpea ones do have nutritional value, and I remind him that they are also fried and oily enough to lube his car. Lunch is usually something small like soup with rice balls or one of the many corn-based dough balls native to Ghana. The two main soups are a peanut-based one and a palm oil-based one. Both are very tasty, but I constantly remember Dennis, as we ate palm oil soup on my very first day in Ghana, telling me “Delicious…but VERY high in cholesterol.” Also, the vast majority of carbs I have encountered so far are the bad ones: white rice and white bread predominate healthier alternatives. The favored proteins for dinner are fish and goat meat. These are not too bad, but the fish is usually fried. Healthier bean-based dishes can be found if you do some searching, but it’s much more common to find fried fish and fried plantains. A late-night snack, which I have fallen prey to many times, is the plantain chips. Very similar to potato chips, they are made from plantains, a banana-like fruit, and the chips are sweet, salty, crispy and delicious…but definitely not good for you. So, what does all this mean?

fried doughnut balls and chickpea patties: breakfast of champions

In my first week, we visited a woman from Dennis’ church whose husband had just passed away from heart disease. In a country where the male life expectancy is under 60, he was under 50. When we pulled up to the house, she, along with several family members and friends, was sitting on the porch in all black observing what I took to be the Ghanaian version of what the Jews call Sitting Shiva: a week-long mourning ritual. Except that the Ghanaian version, I would learn, can last anywhere from one week to several months, depending on circumstances, and we would visit this woman 3 more times over the next week or so. I also learned that the man had well-documented high blood pressure and had been given medication for it from his doctor: medication he did not take. Dennis said that this is very common with hypertension medication in Ghana. It’s not that people are leery of or don’t understand Western medicine, but it is cultural. He explained that the symptoms are not overt, and because they cannot be felt on a daily basis, people just don’t take the pills. In my first 3 weeks, Dennis attended these observances for 2 other people as well, both of whom died from different chronic conditions (stroke and diabetes).

My Ghanaian experience is a microcosm of current global trends in disease burden shifting away from infectious diseases and towards chronic ones. And nowhere is this happening faster than in low and middle-income developing countries all over the world, where over 80% of the world’s population resides. As economies develop and individuals become better off financially, this expanding middle class is able to use the extra disposable income on red meat, cigarettes and sugary drinks. Add onto that the simultaneous demographic trend of rapid urbanization, where the masses moving from rural areas into cities find both everything they need in a smaller radius and the need to walk around and exercise less necessary. In fact, chronic disease experts agree that diet, along with tobacco use and lack of exercise are the three main factors driving this global trend.

sign at a hospital I recently visited

In 2003, employees at Goldman Sachs came up with a clever acronym for the largest, fastest-growing, developing economies in the world: BRICs. BRICs stands for Brazil, Russia, India and China (sometimes the S can represent South Africa), and together, they will completely redistribute the world’s power and financial balance sheet in the foreseeable future. They are also leading the pack for the changing disease burden. While Wall Street and the rest of the private sector is busy setting up offices in Durban, Bangalore and Sao Paulo, angling for this emerging middle class to provide their future revenues, the citizens of these countries are acutely experiencing some of the less-desired effects of this “development.” In 2000, none of these countries ranked in the top 5 global economies, in terms of GDP. By 2050, all 4 BRIC countries are projected to be in the top 6. In Russia, wages TRIPLED from 2001 to 2006. Income is projected to TRIPLE in India from 2005 to 2025.

But these huge economic gains are not being translated into reciprocal health benefits. From 2005 to 2030, life expectancy is only projected to increase, on average, by less than 5 years in BRIC countries (about 2-3 months per year). According to the WHO, three of the top 4 causes of death worldwide – cardiovascular disease (CVD), cancer and chronic respiratory diseases – are associated with chronic conditions. These three, together with diabetes, accounted for 60% of worldwide deaths in 2005, with more than three quarters of them occurring in developing countries. From 2005 to 2030, India, Latin America and Sub-Saharan Africa are projected to experience double digit increases in CVD burden. Over the same time span, the BRIC countries may experience a 3.29% compound annual growth rate in diabetes incidence. Similar projections can be found for cancer, respiratory disease and other chronic conditions, and this entry could go on and on.

Concession stand filled with doughnuts, meat pies and other deep fried things in the lobby of the SAME HOSPITAL

My former boss at the Center for Global Development, Rachel Nugent, is a population economist and an expert in this topic, so I was fortunate enough to be somewhat prepared. However, as I am finding out over and over again, it is a completely different animal when you experience it first-hand. Going to the mourning observance for someone who died from a very preventable and treatable condition is one thing. Consciously trying to exercise and eat healthy foods and finding it very difficult to do either is another. But Americans can rest assured that while we continue to lead the world in obesity, thousands more decide to join our ranks every day. I’ll keep fighting the good fight, but in the meantime, our fridge is never without Coke, and the plantain chips are delicious.

close-up of some plantain chips

Happy Holidays

The holiday season is upon us, and I thought it appropriate to give you all an early present. These have been a long time coming, but here are pictures of some of the people and things I've been blabbering about. Enjoy.

Desmond, talking to his little sister after Chruch. Desmond refused to pose for a picture. So, I took it upon myself to take one of him by surprise. This is the best I did. I have many of him turning away at the last second.

Charles, the fun-loving ladies' man and PSGH's crazy driver

Some color-coded girls walking to school in the morning

Patricia

People carrying goods on their heads, selling them in the middle of the road

The Upside of No Social Life

My next entry will probably be about chronic diseases, so I wanted this one to be a little more light- hearted.


I will be the first to admit that I don’t have much of a social life here in Accra, yet. The apartment and office are near one another, on the outskirts of the city, quite far away from both the night life and where the white people hang out (an area called Oxford Street). The only public transportation available is in crowded (“private”) vans or personal taxis, and I don’t really have a desire to do either just yet. So far, I drive to and from work and home with Dennis, and I pretty much do what he does. As he is a pastor, who also has a full-time job, it’s safe to say that he doesn’t exactly party like a rock star. Dennis, Patricia and I spend our nights eating dinner, watching TV (mostly soccer) or DVDs, and getting to bed at a decent hour, as Dennis and I leave for work at 7:30 every morning. But I’m definitely not complaining…it’s really not that bad.

Dinner has markedly improved over the last two weeks. We went to “the market” over the weekend (another blog entry for sure), so I now have a good stock of food and spices and have gotten into the swing of cooking for myself. Sometimes I’ll try what Dennis and Pat are having, and it’s usually pretty good and always interesting. They are getting to know what I do and don’t like, so the bad surprises (intestines, liver, etc.) are fewer and farther between.

As for TV, that’s a different story. We get about 7 or 8 channels, and when we get home from work, the line-up has become pretty predictable. 3 of them are news channels. The SABC (South Africa Broadcast Company) is pretty high-quality and focuses mainly on African headlines. Then there is PressTV: a very high-quality broadcast that is actually based in Tehran. Sometimes they like to portray the US and its allies in a not so great light (as with the IAEA sanctions against Iran recently), but more often than not, I find it to be fairly objective and very good (ie: Sean Hannity and Keith Olbermann could learn a thing or two). Finally, there is local Ghanaian news; it’s pretty budget, but I find the topics very interesting. Lately, they have been discussing the new budget proposed by government and what Ghana should do with its forecasted oil revenues (definitely a future blog entry). Once you get passed the news, there is one channel that always seems to be broadcasting a terribly-dubbed Spanish soap opera. Another channel usually always has a soccer or rugby game on (often it’s from the Dutch, Scottish, Russian or another lesser league). The “American channel,” as I call it, which I suppose I am to find solace in, seems to alternate between reruns of Oprah, America’s Next Top Model, and CSI Las Vegas. And those of you who know I feel about these shows know that, in my humble opinion, this station might as well be static. The programs on the other few stations are a wildcard of televangelists, Ghanaian shows, science-y shows and the featured soccer matches (always the English Premier League) and featured movies (they have a weird thing for Eddie Murphy movies here).

As I said in a previous blog, Dennis and Desmond enjoy movies, and we have many DVDs. We don’t see Desmond much during the week, as he lives in Tema, but he comes over to spend the night on weekends, and that’s when we do the movie watching. Pirated DVDs from China are the norm here, where anywhere from 9 to 90 movies are contained on one disk, and we have many. Ostensibly, they all have themes – Harrison Ford movies, epic war movies, Wild West movies – and Dennis and Desmond seem to favor the action-packed ones.

The lack of a social life has also given me ample time to read. I’ve already finished one book – a fantastic read about microfinance and international development entitled “The Blue Sweater” by Jacqueline Novogratz, founder and CEO of the Acumen Fund (thanks Mrs. G. for the gift) – and started on another: “Selected Stories of O. Henry.” In times like this, I like to read the “classics” that have yet evaded me. When I studied abroad in Spain, I read “The Catcher in the Rye, “Lord of the Flies,” and many others. (No, I did not have to read them in high school.) However, I don’t think that I’m quite ready for the Kafka or Sun Tzu that I brought with me. And, when it comes time to applying for grad school, I imagine that will take up a significant amount of my time as well.

Another good thing is that I’m not spending much money these days. A penny saved is a penny earned, so it’s almost like I have a salary! An old coworker and friend of mine has been consulting for the World Bank for the last two months in the Tanzanian capital of Dar es Salaam, and she has had a very different experience thus far. Like most ex-pat aid workers, she socializes mainly with others of her kind (aka: white people). They lounge in expensive rented villas; spend money on gym memberships, massages and gasoline for their cars; and go out dancing and drinking ‘til all hours. If you don’t believe me, please read her blog. As she is a professional writer, I will admit that it is much better than this one. But I am glad I am not doing things that way, if only for the reason that the money I saved would last me about half as long as I’d like it to. Also, I don’t think she would argue that I am probably having more of an “authentic” experience living and working with only native Ghanaians. Last week I had my first conversation in 2 weeks with a white person: a missionary’s wife from “central Pennsylvania” who approached me after overhearing me talking to Dennis at the grocery store.

Like I said, I’m not complaining about being a loser, but there is a light at the end of the tunnel. I fully expect to procure a bike soon, to make myself more mobile. And, as of this writing, I doubled my “conversations with white people” tally this past week, bringing the grand total to 3. One of them, an analyst with the Clinton Foundation that I met at a Global Fund conference on Wednesday, invited me to a (sushi) dinner with him and some of his friends this weekend. He lives on Oxford Street, so yes, they have a sushi restaurant for the rich white people that coalesce around that part of town. I’m a little apprehensive about being one of the “obrofo” (the Twi word for white people, plural; “obroni” is the singular) patronizing a sushi restaurant on Oxford Street, so we’ll see how it goes. But at least I have something to do on a Saturday night.

Ghanaian Efficiency Strikes Back

I would like to apologize for the recent decline in new updates. It's not because I have not been writing them. On the contrary, I have not had internet at my work for this past week to enable me to post them.

I wrote this entry before my office lost internet for the week, so the irony of this entry being about Ghanaian efficiency is certainly not lost on me...but it's still a good story.


I love efficiency of all kinds. Whether it’s small-scale (plotting out the errands you need to do on a Saturday morning in order to travel the shortest distance) or large-scale (re-orienting the divisions of your business to open internal lines of communication that did not previously exist), the economist in me (yes, it was one of my majors in college) really enjoys it. Now, I realize that my work experience thus far tallies more than a few non-profits, not exactly representing private sector, profit-driven efficiency at its best, but I have worked with several MBAs and PhD economists, and it doesn’t stop me from liking it!

A few of my previous posts have described how inefficient things can be here, or in any developing country, when compared to the “Western World.” So, I wanted to share a nice little anecdote regarding something that was MUCH easier and faster to do here than it would have been in the latter. And it all starts with me being an idiot.

As I mentioned when I got off the plane, Dennis drives a nice silver VW sedan that he takes good care of. The model is called a “Bora,” which hasn’t made it to the US, but it is very much like a Jetta or Passat. When I arrived, the rear, driver’s-side door had the child lock engaged, not enabling the passenger to open it from the inside. As that is the only back seat with a seatbelt, I usually sit there (with Dennis driving and Patricia sitting shotgun), and it has proved to be very annoying. After a while, I asked Dennis why it was engaged, and he said no reason. He didn’t even know how it had happened, but he would like it to be disengaged as well. Upon hearing that, I took matters into my own hands: a big mistake.

Dennis' VW Bora

Last Sunday, Patricia and I were waiting for Dennis in the parking lot after church, and I thought it was a perfect time to put my mechanical engineering skills to use. What mechanical engineering skills, you say? Well, that is a very appropriate question, because I have none. But that didn’t stop me from opening the door and playing around with the lock mechanism, trying to undo the child lock. I rotated the hinge on the inside of the door, and then tried to close it. The only problem was that now it wouldn’t close. I tried to undo what I had done, and the door was having none of it. I had completely broken the door’s lock. I told Dennis what I’d done, and he said we would take a look at it when we got home. We had to drive home with me holding the door as closed as it could get from the handle on the inside. Whenever we would go over a bump or make a sharp right turn, the door would open slightly, and I would close it quickly. It was ridiculous, and I felt terrible.

When we got home, I told Dennis I would pay for the repairs, as we examined the bad door and the other good ones. We saw why it wouldn’t close and what needed to be done, but the hinge would not rotate back into its original position. We played with the automatic keyless remote, the automatic lock inside the driver’s door, and the manual lock on the door itself. I even got a few screwdrivers and a wrench I brought with me to make our trials seem more official, but nothing was working. As Dennis looked at the other rear door (passenger’s-side), he began playing with it, and before I could stop him, he had done the exact same thing to that one. So now, both rear doors would not close. Luckily, it was Sunday, we weren’t going anywhere before work the next day, and Dennis said that his good car shop was on the way. Knowing all too well how much fixing a German car can cost, I fell asleep thinking the worst.

When Dennis and I drove to work in the morning, I had to be in the ridiculous position of the middle rear seat, with both arms extended holding each door closed from the inside. As we pulled up to the Dennis’ “good car guys,” the shop consisted of an air pump, dozens of tires stacked in piles of different heights, tools strewn about seemingly at random on the ground, and a few cars outside in various states of rundown. There was no building, but rather a covered dugout of sorts where 4 men in their late teens or early twenties sat chatting on a triangle of benches. As we pulled up, one of the men pivoted off of his bench and walked over to us, as Dennis got out to meet him. Needless to say, I did not think we would have any luck here.

The best shot I could get of the car "shop" from my passenger seat

Dennis and the man spoke is rapid Twi, as I remained in the rear middle seat looking over at them. The man opened the rear passenger-side door, examined the lock, and began playing with the door handle. After 10 seconds, he called over to one of his partner, who brought him a screwdriver, and in another 10 seconds, he had fixed the first door. He opened it and closed it to make sure, and then went around to the driver’s side and fixed the other one in no time. A feeling of combined relief, stupidity and awe came over me. The man walked away, as Dennis handed him 2 Cedis (less than $2) as a thank you.

The rest of the way to work, I couldn’t stop telling Dennis how cool that was. They had fixed both doors in under 30 seconds, and we payed less than $1 per door. In the US, I assured him, if you took a VW to the dealer to fix the same problem, they would tell you it would be ready in a few hours minimum and then charge you at least $50 for the labor alone. He just laughed.

PS: I am happy to say that when we were fidgeting with the two doors, trying to fix them, I figured out how to actually disengage the child lock. So, it all worked out in the end, and now I can ride with a seat belt and open the door for myself when we stop!

The Good with the Bad

On this Thanksgiving Day, I am thankful for the times like this, when the power is on and the internet is working. It provides me the opportunity to be online, to post blogs like this, and to Skype with my mom, Gordy and Ashley, as I just did. In America, most people would not count these as some of their blessings, but in Africa, they certainly are.

Not only is internet availability a privilege for few, but this week alone we have experienced daily power outages, some lasting 20 minutes, others a few hours. While I am told that they never happen with this frequency, the fact remains that they are. During these outages, all lights go off (obviously), but it also affects the air conditioning (a pretty big deal) and the internet, due to the fact that the router is now off. In addition, all desktops are now off, and despite the advertisements, my laptop, which is now forced to run on battery power, doesn’t have more than an hour or so of juice left. That email I was about to send will have to wait.

For all intents and purposes, office life comes to a halt. Yes, there is always reading to be done, and I have already made a habit of downloading PDF reports when I can (to read in such an eventuality), but the rapidly rising temperature makes it almost unbearable in the office. We do have a back-up generator, but it takes about 15 minutes to get going, and we wait at least that long to see if this outage will be a short one. On a related note, a former CGD colleague of mine, Vijaya Ramachandran, has researched and written extensively about power outages in the developing world (specifically focusing on Nigeria and India) and the detriment they have to a thriving private sector. The statistics related to the losses in $ faced by businesses due to these outages is large, to say the least.

Our trusty 200-pound generator

Now I know that I have been writing about diseases, power outages and other sour subjects, but I want to put it all in perspective, and end on a high note so that everyone can have a happy Thanksgiving. As I often do, I will relay some quick reflections of two very promising things I saw one afternoon driving around town with Charles. The first has to do with a street vendor of a different sort. Rather than selling food, phone cards or razor blades, he is selling newspapers. Not only is he selling newspapers, but he is selling a variety of newspapers, from across the political spectrum. These papers are not government-controlled propaganda; but rather, they are very reputable publications, many critical of the current government, and they represent the very essence of what it means to have freedom of the press.

Front cover a popular newspaper called the "Daily Graphic"

The other one has to do with a billboard. No, this is not one about HIV. This promising billboard is one for an opposition candidate running for president: a remnant of last year’s VERY heated presidential election (internationally certified to be free and fair) that had to be decided in a run-off. It represents the strength of democracy in Ghana. Democracy is so well-rooted in society, that earlier this year, President Obama came specifically to Ghana to congratulate its citizens on their successful and peaceful transition of power and emphasize how Ghana is a “beacon of hope” for the rest of the African continent.

The election billboard

Just like reliable internet and being able to live and work without daily power outages, a free press and strong democracy are things most Americans take for granted. Most will not consciously be thankful for them on this day. But in the developing world, these advances cannot be underappreciated. So remember, Ghana may have its fair share of problems, but at least it’s not Somalia.

Now have a very happy Thanksgiving and pour some gravy and/or cranberry sauce out for a guy who will go without this year.

Like Two Cars Trying to Cross a One-Lane Bridge

Every day I learn more and more about the cultural dynamics at play in Ghanaian society. Some of them I almost expected, like the fact that women are expected to do all of the cooking and cleaning and domestic work, while the men are expected to have the paying job. Others have caught me completely off guard. For example, I just learned that going out to eat has a negative connotation here. Since groceries can be very expensive, eating out is often a more affordable option; however, as Dennis explained to me this morning, it is often seen as the option of last resort when the woman of the household is not capable of cooking the requisite meal for her family. “Pat would never allow it!” he said. I told him that in the U.S. it is almost exactly the opposite: cooking is generally cheaper and eating out is often considered a treat.

Another thing that I expected to see was the large adoption of Western technologies. It is quite ignorant to think that Africans want to be just like us, and that the goal of international development should be to make it so. However, cell phones and the internet are examples of transformative technologies that have completely changed the way we live and work, making it possible to communicate and interact in ways unforeseen only a generation ago. Most Africans feel the same way, and, seeing the greater efficiency and enhanced connectivity made possible in their personal and professional lives with many Western technologies, they have welcomed them with open arms. Without a doubt, the most advertised item in Accra is the cell phone, and I saw an Apple store on my first day. This is all the more reason why I was completely dumbfounded to witness the vast inefficiencies in the workplace stemming from the lack of use of these technologies.



It happened during another eventful day of driving around Accra with Charles. This time we were accompanied by Dennis, who had to go to some government ministries to personally enquire about the status of approved funding (which was now owed to us), as well as knock on a few other doors to get certain things moving. He wanted me to come to better understand the “politics of Ghana” and the organizations, associations and ministries with whom I would be working.

We arrived at the first government ministry office, where Dennis was following up on some emails and phone messages he had previously sent, from which he had not heard back. When we opened the door to the office, four desks piled high with files sat in a very cramped room full of about a dozen people – one person behind each desk and the other eight or so mulling about doing nothing in particular. Dennis found the person he was looking for and spoke to him for about 2 minutes. There was a lot of nodding, and then Dennis turned to leave, motioning for Charles and me to follow. I asked if everything was ok, and he said, “Yes, we will get our money now.” We then went to two or three other offices where the same thing happened. Even though it had taken us hours to get everywhere in the traffic, we never stayed at one place for more than 5-10 minutes.



As we left the third stop where this same scenario has unfolded, I said “I don’t get it. Why did we need to come all this way, when a phone call or an email would have sufficed?” Dennis and Charles just laughed. They said that the previous phone calls and emails served mainly to broach the subject, and many times they are not returned, let alone in a timely manner. More often than not, in order for things to actually get done, an in-person visit is required. During this visit, the emails and phone messages that have been sent to the person are discussed, where the individual will confirm their receipt and that they intend to follow through on whatever it is. If these messages are not sent before the in-person visit, the person will just say that they have no idea what you are talking about.

“But that’s so inefficient, especially when it takes us so long to drive here.”

They laugh even harder. “That’s Ghana” they say, which reminds me of “It is what it is,” a favorite phrase of my best friend, Jeremy, who stole it from his father. It’s a phrase which is simultaneously both profound and inane and can be said of anything under the sun. “You’re right, it is very frustrating. It was not this way in Germany” says Dennis, who got his masters degree in Berlin and has also studied in Norway.

In DC, the government is the butt of many jokes and the cause of much frustration regarding bureaucracy, red tape and inefficiencies. I’m not sure if this phenomenon is exclusive to the government here, but as of right now, my diagnosis is that this need for a face-to-face interaction may be cultural (More investigation to be done, so stay tuned). I was prepared, as many told me before leaving, for life to move at a slower pace here, but this lack of use of readily-available technologies is certainly surprising. An economist would term this "higher transaction costs" - the cost of making a transaction - and higher costs are always a bad thing in economics.

This conflict between “Westernization” (for lack of a better term) and the preservation of native cultural norms reminds me of something else that happened last week that may be serve as a nice metaphor. Perhaps it is not an appropriate metaphor at all, but I thinks it’s a good story in it’s own right, so here goes:

As Dennis, Pat and I were headed to Church last week for Pat’s women’s bible study (Dennis and I would run some errands during it), we came to a stop in front of a one-lane wooden bridge over a little brook. A steady stream of cars were coming over it from the opposite direction, and we were first in line to go over as soon as it let up. The only problem was it wasn’t letting up. I asked Dennis if there was a traffic cop* on the other end who would stop the cars at some point, and he just laughed. After 5 minutes, and prompted by honks from the line that had formed behind us, Dennis decided to take matters into his own hands. At an opportune moment, he turned into the traffic and began to cross the bridge. Inevitably, about a quarter of the way across, we found ourselves nose to nose with a car from the other side. A standoff ensued for a good 30 seconds before the other car put it into reverse to let our side have its turn to cross.

*Say what you will about traffic cops (I will readily admit to despising them, as they invariably prove themselves to be utterly worthless 96% of the time), but in this instance, we could have used one in Tema, Ghana.

Of Input and Output

No one likes to talk about diarrhea. Except, of course, my father, a gastroenterologist, who would routinely take work calls at the dinner table and end up discussing stool samples and bowel movements of all kinds over the evening’s repast. But I digress…

On our way home from church last Wednesday night (yes, they attend Church on Wednesday, too), Pat, Dennis and I stop by a roadside market to pick up some food for dinner. At first glance, the market is just a few kiosk-type booths next to one another on the side of the road selling mostly fruits and fish (Accra is right on the coast, so everyone sells fish.). But once we park and get out of the car, I notice that these few booths are just the façade of about 5 times as many behind them. We begin to walk back about three or four booths deep before stopping in front of one whose countertop is crowded with glass cases of fish and shrimp, along with a huge pot full of shotput-sized balls of something wrapped in corn husks that gives off a plethora of steam when the woman behind the counter removes its top. We buy a good amount of the fish (fried tilapia, I would learn) and shrimp (also fried), together with 4 of the corn husk balls, and head back home.

“In Ghana,” Dennis explains to me as he pops a whole shrimp (shell, tail, legs and eyes, as well) in his mouth, “everything is eaten with your hands.” This meal happens to be very traditional Ghanaian fare: the shotput things are called “kenkey” – a sort of corn-based dough ball that is fermented for a few days to give it a bitter taste – served with seafood and hot chili sauce for dipping. Not only are utensils not required, but Ghanaians also eat ALL of the fish and shrimp: the eyes, tail and everything in between. I don’t think there are extensive catch-and-release laws in Ghana, so the fish are pretty small – at most a foot in length – making bones almost a nonissue.

So there I am struggling with fork and knife, removing head and tail, while Pat and Dennis are just putting it away at a very respectable clip, their only utensils the ones they were born with. When I comment on how I expected the chili sauce to be spicier, I learn that Pat does not like things too spicy, so she diluted her chili sauce (and mine) with tomato paste. I say that it is a very sweet gesture, but I do, in fact, like spicy things (Many of you know that I enjoy cooking and eating with a lot of spice: the more the better.). So, after some cajoling, they let me try some of Dennis’. It is definitely not for the faint of heart or weak of stomach, but nothing I can’t handle (I’m pretty tough, I know.). Dennis and Pat are continually surprised when I like Ghanaian food, but even more so when I reach for more of Dennis’ chili sauce.

Now I’m sorry to say this, but in the middle of the meal, I can’t help myself except to think about diarrhea. And not because I am walking a thin line with the chili sauce, which I might regret in the morning. Diarrheal diseases – a blanket term in the global health world for many food and water-borne microorganisms (shigella, rotavirus, cholera, enterotoxigenic E. coli, etc.) that cause it – are a very serious problem in developing countries, especially for children. And despite proven prevention and treatment interventions, diarrhea, together with malaria and malnutrition, remains one of the top 3 killers of children under 5 worldwide. For Westerners, it is called “Montezuma’s revenge” or traveler’s diarrhea; something only encountered on tropical vacations. But for children in the developing world, it too often leads to dehydration and death. In fact, this scenario might be spreading for older people as well; a new WHO report concluded that the OVER-5 mortality rate from diarrheal diseases might be 3 times as high as previously thought.

When I went to the travel clinic for my immunizations before leaving for Ghana, in addition to learning what it’s like to feel like a human pin cushion (5 shots in under 1 minute), the clinician delivered a kind-hearted lecture of the do’s and don’ts while abroad. For avoiding the food and water-borne illnesses, she cautioned: “Don’t eat the fruits or vegetables unless you can peel them. Don’t eat the meat unless it’s boiled or baked for the necessary amount of time. Only drink bottled water or water that has been boiled or treated. Don’t eat any of the spices. Don’t eat any of the rice, or other locally-harvested things. Definitely don’t eat any of the local food from the street vendors, and watch out for the food on the flight coming home.” Basically, don’t eat anything. Now, adherence to such pointers might be possible for week-long vacationers, but when you are going for a year, such advice becomes infeasible. And while I certainly try my best to adhere to these rules, I have already broken them several times over.

Back to the meal at hand (pun not intended). I am sitting there worried about eating with utensils that have been washed with tap water – water that had certainly not been boiled –, while Dennis and Pat are eating with hands that had, at best, been washed in the same water. Now, Dennis and Pat are very hygienic people who shower and wash their hands regularly, but the same cannot be said of all Ghanaians (or all Americans, for that matter), especially those in more rural areas without regular access to showers and hand soap. Like malaria, according to Dennis, the adult population becomes relatively immune to many of the food and water-borne disease-causing microorganisms. And after a time, he says, I might even be able to drink the tap water consequence free. This is all well and good for Dennis and Pat, but it’s a different case entirely for the toddler I witnessed being hand-fed by her mother only a few hours ago.

Now, I am not going to start telling Ghanaians to eat their Snickers bars with a fork and knife like George Costanza, but this proclivity for eating with hands is the sort of thing that makes one look quite differently at the motherly admonition to “Wash your hands!” It is the sort of thing that never occurred to me when researching diarrheal diseases from an office in Washington DC with instant hand sanitizer on my desk. It is the sort of learning from experience that makes me thankful for coming here.

His Holiness Haircut

The missionaries did a tremendous job in Ghana. This theme of Christianity will probably be a recurring one on this blog. Even without Dennis’ daily reminders that “We Ghanaians live by the faith,” I would have to be blind not to realize it. And even if I was blind, there would probably be a nice person leading me by the hand as a personal reminder. Every day when Dennis and I drive to work, we pass by myriad signs for such and such Anglican or Presbyterian Church. And if the churches, the pastor sitting next to me, and the bibles in the back seat weren’t enough of an indication, the signs above the storefronts crack me up every time. “His Holiness Haircut,” “The Blessed Plumbing Works,” and “It Is the Lord Shoes” are just three of the ones I can remember off the top of my head. No, I am not making this up.

But my point in writing this is certainly not to poke fun. It is merely to give you an indication of the culture and the people of Ghana. Their faith stems from thanking God for all that he has given them, when they could very easily lament that which he has not. And as I said in a previous blog, which was then confirmed in a tourism book I purchased, Ghanaians are known as “Africa’s friendliest people.” There could be much worse places to be!

PS: If you are confused by the top picture of the "In God We Trust Beauty Salon", it was taken from our car as two women with platters/baskets of smoked fish on their heads walked by. That is what you are seeing.

Why It’s a Good Thing That Dennis Had Malaria Last Week*

*Disclaimer: This blog takes a very simplistic stance on the very complex topic of malaria endemicity. I would like to personally apologize to any public health professionals who may be reading this. Also, with a sample size of 1, a more appropriate title would be: “Why It Could Be Seen As a Good Thing That Dennis Had Malaria Last Week.” But that title isn’t as catchy.

It can be the very definition of growing pains. And something that can be tricky to explain to those who don’t deal with it every day; so let me have a go at it:

In areas of high malaria transmission, individuals are bitten by infected (vector) mosquitoes on a constant basis. This is an enormous problem for children and pregnant women, but by adulthood, an acquired immunity is developed whereby the malaria parasite (usually Plasmodium falciparum) is always in the bloodstream, and each additional exposure to the vector (aka: mosquito bite) rarely results in an episode of clinical malaria. This scenario is euphemistically termed “stable malaria”.

In areas of lower transmission, individuals are bitten by infected mosquitoes less often, and the amount of malaria parasite in the blood stream fluxuates. This is a somewhat better situation for children and pregnant women; however, immunity is not acquired in adulthood, at least not as consistently, and each new vector exposure leads to an episode of clinical malaria more often. This scenario is called “unstable malaria”.

Now, it may seem like both scenarios have their pros and cons, and one is not necessarily better than the other, but lower transmission is certainly better than higher. (Think of which one is better for the women and children, sort of like a Titanic/life boats situation…They are more important and get saved first.) And the end goal of all malaria programs is eradication: the elusive E word. In order for that to happen, areas of high malaria transmission will have to become areas of lower transmission before they can become malaria-free areas. Alas, for my friend Dennis, these growing pains can be literal pains indeed. (Though he seems to be smiling now.)

A somewhat related “growing pains” type of situation worth mentioning is one from the field of HIV/AIDS that my old CGD colleague, Mead Over, an expert in AIDS economics, deals with on a daily basis. It has to do with the difference between incidence and prevalence, and the fact that, counterintuitively, higher HIV prevalence rates can undoubtedly be a good thing. Incidence refers to the amount of people newly diagnosed with a disease over a certain period of time; a lower number here is almost always better**. Prevalence, on the other hand, refers to the number of people currently living with the disease. And for HIV/AIDS, the main goal right now is increased access to ART (antiretroviral therapy). Thanks to the great advancements in these HIV drugs, people are now able to live much longer lives with the disease. And higher prevalence rates – more people living with the disease – means more people not dying from it. Seems straightforward enough, but it still causes headaches for Mead and other AIDS experts dealing with policymakers doling out the money.

**Higher incidence rates can also be a somewhat good thing if great strides have been made in the number of people being tested for a disease. Obviously, it is not a good thing that more people have the disease, but it is better that the higher burden is now known by public health professionals. This happened recently when the HIV/TB co-infection rate jumped from 1-in-8 to 1-in-4 almost overnight.

"Sexy, Can I...Just Wear a Condom?"

Let me explain. The Pharmaceutical Society employs a driver who runs errands (picking up checks, delivering letters, etc.) all day all over greater Accra, because the national postal service takes up to 4 or 5 days, and I suppose this is considered more efficient and cost effective. His name is Charles, and he is a short guy (maybe 5’5) with short hair, a little goatee and big, wide eyes. I am to go with him because I need to make a few stops myself (U.S. embassy and National Malaria Control Program), so we leave the office around 11am. What I didn’t know is that the combination of multiple errands to run all over town and Accra traffic means that I am spending the next 5 hours with him. It is 5 hours of a great education.

I buckle up, he flips on the radio and we’re off. Charles is very affable, and it is clear after a few stops that he knows many people all over town. By Ghanaian standards he is a very good driver (aka: extra crazy). The only stop sign I see all day is blown by us, as Charles waves to the taxi that honks, swears and slams on its breaks to avoid hitting my front passenger side door. Traffic is bad, even in the middle of the day, and hundreds of people are employed by hawking goods to the cars stopped in the gridlock. Even when traffic is moving, they do not leave the middle of the road, and I have a fleeting thought about correlation vs. causation. Men and women of all ages carry baskets of wares atop their heads, selling everything from bags of water and nuts to neckties and paintings.

Charles' radio station of choice blasts a mix of international and local rap and R&B in between commercials for hair care products and PSAs about making sure to wear a condom when you have sex with your girlfriends (but not your wife). It is a nice change of pace form the music that Dennis plays in his car (only Gospel). The radio station is very into international entertainment news as well, and I soon learn who Alicia Keys is in the studio with and when Shakira’s new single is dropping. As I hear a string of Eminem, the Ying Yang twins, that “Blame It on the Alcohol” song (I think it’s Jamie Foxx) and “Sexy Can I”, a thought occurs to me: Have donors ever considered paying popular artists to sing about their issues of concern? Can the World Bank pay Rihanna to sing about how sexy it is when people wear condoms? Can USAID pay Jay-Z to talk about how only true ballers adhere to their entire regimen of TB drugs? (Two related thoughts: Like movie stars that endorse foreign products overseas, Westerners don’t even have to know about it. Also, Ghana is an English-speaking former British Commonwealth, so it occurs to me that this type of campaign would probably be less effective for its Francophone neighbors, but I still think there might be something there…)

It is now the middle of the afternoon, and school children in their brightly-colored matching uniforms and backpacks can be seen walking next to the goats on the side of the road, as we make our way in the traffic. I contemplate a sign above a nearby shop declaring “Herbalist - HIV Has a Natural Cure!” and continue to notice the school children. Without having to turn my head, I am able to see the color-coded kids walking away from me and other ones walking towards me with a basket of fruit and a bag of soccer balls, respectively. What is the difference between those children on the side of the road and those in the middle of it? Between those carrying backpacks instead of balancing an open box of jewelry on their heads. These depressing thoughts stay with me for a bit, but a few miles down the road I see something that improves my mood. It is a billboard from the Ministry of Health promoting HIV prevention that states: “Abstain, Be Faithful, OR Wear a Condom Every time!”, and I am overjoyed that the Ghanaian government has taken the sensible approach of giving their citizens options…I guess that was too much to ask for from the Bush Administration.

My First 24 Hours

I would first like to apologize for how long this entry is going to be – I had no idea I would have so much to report in one day – so please feel free to stop reading at anytime. Future entries will undoubtedly be MUCH shorter. I would also like to apologize for the lack of pictures, but I have not yet figured out how or when to take them without seeming patronizing.

7:30am-9:30am
My plane arrived on time at 7:30am (1:30am Chicago (my) time) to Accra’s Kotoka International Airport. My two checked bags appear on the carousel within 10 minutes….impressive. They are soaking wet; I think because it was pouring in NYC where I had a two hour layover: I guess it was too much to ask for the bags to be covered. Now all I have to do is wait for a small carry-on which they made me check at the gate due to a phantom lack of overhead compartment space (there was more than plenty to go around) and change some money before I try to find my new coworker/housemate, Dennis, who has arranged to pick me up. I did not end up leaving the airport until 9:30, so you do the math on how long that took.

Now I find my way outside the airport pushing one of those trolleys with my two big bags on top and pray that he is there, since I have no phone (that works in Ghana) yet and a very vague idea of where the apartment is: all attempts to googlemap (that’s right, it’s a verb now) the address Dennis gave me proved futile. As luck would have it, he is still there (a kind-faced man in his 30s with an imposing stature and no hair), flanked by his wife, Patricia (Pat- an attractive, full-bodied woman about my height) and their friend, Desmond (jolly in every sense of the word – short, stout, chubby cheeks, huge smile). Apparently they were about to go check with the airline to see if I had boarded the flight. Regardless of other factors, I had arrived with all of my bags intact and my ride was there: no complaints here. As we head to the car (a very nice VW), we fend off several sketchy men who follow us all the way to the parking lot and then make the money motion to me (sliding index and middle finger against thumb), as if I am supposed to pay them for doing nothing more than unsolicitedly following us for about 100 yards. I’m just glad I am not alone with my big bags.

9:30am – 10:00am
Desmond, who quickly tells me his is an IT guy, and Dennis place my bags into the car. Ghanaians are known to be extremely kind and polite, and I find them no different. I try to pay for the parking, but they won’t let me. After they learn that I am not currently sleepy, even though I have not slept in some time, they ask if I would like to go to church with them, so I jump at the chance to witness a Ghanaian Sunday mass. It turns out that when Dennis is not being a pharmacist during the work week, he doubles as an associate pastor at a Pentecostal church. The church is in a city called Tema about 30 km (18 miles) East of Accra. The road from Accra to Tema is a very nicely paved highway, two lanes on each side. I don’t think anything of it until Desmond asks me if I know who Kwame Nkrumah is. He is pleased to know that, in fact, I wrote a paper on him and Gamel Abdul Nasser for a college history class. He states that Nkrumah was the greatest African leader in history and that the road epitomizes Nkrumah’s vision: He got a lot of slack for “wasting resources” by making it four lanes instead of two, because at the time it was built, Accra and Tema were a small fraction of the population that they are today. But now, they are big cities, and no one complains about the size of the road. They find out that I also like soccer (football), and when I comment on Ghana’s U-20 team beating Brazil’s to win the World Cup last month, they are very pleased that I can walk the walk. I also learn two words in the local language of Twi (Akwaabah, meaning “welcome” and Medasi, meaning “thank you.” We drop Desmond off at his house for him to change into nicer clothes, and then I ask if I can do the same. We go to Pat’s family house, where I quickly change into a shirt and tie, after fishing them out of my bags in the trunk.

10:00am – 1:00pm
Nothing could have prepared me for the Ghanaian Sunday mass: It is fantastic in every sense of the word. I’ve been to over a hundred Catholic masses, I’ve seen the Baptist ceremonies of singing and dancing and “Amen” and “Hallelujah” from popular culture, and I’ve caught a few of the ridiculous Evangelical ministers on TV in the states, but this blows them all out of the water. I learn that it is a fairly new Church, and they meet in an outdoor but roofed school hall for lack of their own proper building. It starts with reading groups, where Patricia and Desmond split off into 2 of 3 separate groups of about 20 people each to read bible passages and clap and sing, while Dennis goes to the altar to prepare for the service. Dennis gives me a bible, and I sit alone and start to read Genesis. So far, so good.

After about 20 minutes of reading groups, the service is about to start and chairs are brought out to create rows of pews. I take a seat in the fourth row and Desmond motions to me to get up and we carry two chairs behind the very back row. He says it is better for us back there, so that we will not disrupt the service… Band instruments are unveiled beneath a big tarp: guitars, drums, tambourine and keyboard. It begins with songs played and sung so loudly that Black Sabbath would approve. The songs are half in English and half in Twi, so Desmond kindly provides translation. It is getting pretty heated as people start crying, while others clap and yell and raid their arms for 10 minutes at a time. Some members face the walls of the hall as they cry and sing and pray. As opposed to some other sects of Christianity that stress penitence and punishment for sins, the most common theme of this group’s songs is about thanking the Lord for all that he has given them.

The songs go on for about an hour, and then it is time for Dennis’ sermon. He takes the stage to discuss (and sometimes scream) giving gifts to the Lord and others, and how that encourages others to give: a very nice topic. With Desmond’s continued translation in my ear, parishioners continue to face the walls as they cry and yell and pray. It becomes clear to me that these Ghanaians are more passionate about Jesus than I have ever been about anything in my life (except maybe the Harry Potter books). At one point, a woman in the back row who had been facing the wall is overcome with emotion and falls to the floor. She continues to sob and yell as she rolls around on the ground for about 5 minutes, while no one gives her a second look. At some point, the international developer in me thinks about how religious groups can be better used to move education, health and other agendas forward. The sermon lasts about an hour, followed by another half hour of songs after that, and then we are done…3 hours total.

1:00pm – 6:00pm
We are finally headed home, which is great, because I am starting to feel exhausted. As we head back on the paved highway, Desmond is quick to discuss politics. He asks me if I like Bush, and after he decided it was ok, he boldly states that Bush might go down as the worst American president in history. We discuss local politics, and he says that in Ghana, there are no legal mechanisms for public funding of elections, and that politicians are innately corrupt, because they have to campaign with private funding (or funds from other nations) in exchange for rewards, contracts, etc. when they take office. We move on to discuss Obama (Ghanaians generally love Obama); America as a giving nation (in relation to the sermon), in terms of foreign aid; and then Desmond says that without America, the world would be taken over by Islamic fundamentalists. Thankfully we are somehow able to avoid that conversation and begin discussing movies. Desmond and Dennis are big movie buffs and we discuss “The Godfather” (Dennis’ favorite movie), Mel Gibson and Arnold Schwarzenegger. When we finally turn off of the main highway, I realize why Desmond made a point about it earlier. In a word, the road-traffic situation elsewhere is terrible. None of the roads on which we now travel have line markings, lanes, signals, or signs of any kind. The drivers make Massachusetts drivers (infamously terms Massholes) seem like they are in drivers education cars. I have already feared for my live 7 times. The roads are anywhere from half-paved to fully dirt, the former having potholes bigger than my checked bags. The dirt roads, whose copper-red hue immediately reminds me of the movie “Blood Diamond” (which was set in the fellow West African nation of Sierra Leone), can best be described as undulating, like speed bumps scattered randomly over the entire terrain and each other. We turn onto the road where we will live, and it is the worst of all. Drivers go no more than 10 miles an hour, as they cautiously navigate the terrain, going wherever it is least bad, and praying for their cars. We find ourselves on the other side of the road as much as our own, as that is where the bumps have take us. The cars coming at us do the same, and it is completely ok to pass each other on the wrong side.

We finally pull into our place, and it is much nicer than I could ever have wanted. I have my own spacious room and bathroom, and even though there is no A/C, the ceiling fan keeps the temperature tolerable. I spend the next hour unpacking and then come out into the common area living room to watch a little of the World Cup qualifier between Ghana and Mali on the nice flat screen TV there (Ghana was the first African nation to qualify already, but Dennis and Desmond yell all the same). Everyone is hungry, and before I know it, food is already made. Pat has made spaghetti for me, and everyone else eats a traditional Ghanaian soup made from oil of palm with goat meat and rice balls. I eat the spaghetti, and after telling them many times that I am perfectly fine eating what they are, I finagle some of the soup. It is delicious, and they are surprised that I like it. It is decided that I will take a nap for a few hours, and then we will go to the Mall to buy some things. I pass out before my head hits the pillow.

6:00pm – 10:00pm
For all of you access to finance people, Accra is very ahead of the curve, and the area where we live is called Spintex Road: a rapidly developing street with all kinds of shops, foreign banks and local kiosk/huts. Before we hit the mall, Dennis stops at a Barclay’s Bank (UK) to use the ATM, but is denied when it is out of cash. He tells me that it is very common for the AM to run out of money on Sunday nights. The Accra mall is very nice and new, sporting many stores, including an Apple store, grocery store and cinema. In fact, I could have seen 2012 if I wanted to, but I would never do that to John Cusack. (It would force me to judge him for a role he took when times are tough in the middle of the global recession, and the movie will undoubtedly be worse than “The Day After Tomorrow” and that is saying something.) We go to the grocery store, and I am amazed at how expensive it is. I paid the equivalent of $30 for groceries I could have easily obtained in DC, Chicago or Boston for less than $20. All of the phone stores are closed because it’s Sunday, so we leave and drop Desmond off at his house in Tema and then head to some pharmacies to see about getting me a bed net. We go to two different places and find one kind where you need to hang it by something from the ceiling and another where you need 4 bed posts. We decide that the prophylaxis pills I am taking combined with my bug spray will be ok for the night and we will check out the room and get a bed net after our reconnaissance. Trip fairly unsuccessful.

We return to the house and Dennis flips on the DVD player to show Terminator 2 about ½ over. On the coffee table are DVD boxes which display anywhere from 30 to 80-in-1 disks (One disk contains 80 movies!). I make it about 20 minutes before I’m doing the sleepy head bob, so I leave Sarah and John Connor for my new bed. Thinking that my first day in Ghana was fairly crazy, and that I had slept about 2 hours in the last 40, I fell asleep more quickly than before.

Welcome to My Awesome Blog

Hello everyone!

I just wanted to create this introductory post half to see if I know what I'm doing and half to say that I don't exactly know what this blog will be(come). I was told by several people to start a blog when I went abroad, because it is apparently the cool thing to do. I imagine it will be 1 part personal journal and 1 part reflections on global health/international development as they occur to me. Also, I think and hope that I will have family, friends, coworkers, etc. reading this, so I will try my best to keep everything PG and have something in it for everyone! That's all I have for you right now, as my ride is waiting for me. More to come shortly!