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!