When the Power Goes Out

No one likes being woken up in the middle of the night. Whether it’s because of a loud noise, because nature’s calling, or because someone within earshot won’t stop snoring, a good night’s sleep is a coveted thing that people are willing to pay for (in the form of memory foam mattresses and pharmaceuticals). I have experienced all of these aforementioned phenomena many times, but in Ghana, the one I have come to dread most is not among them. Nope, it’s the power outage.

Why would a power outage interrupt your sleep, you might ask? Well let me tell you. The answer is simple: the fan stops working. Forget no TV, microwave, or electric water boiler. The worst thing about a power outage in Accra, by far, is that the fans stop working, and when this happens at night, forget it. In the middle of the night, the ambient temperature in Accra is around 80 degrees, and it is common knowledge in these parts that sleeping under a mosquito net adds a few degrees on top of that. Even sleeping on top of all my sheets, the ceiling fan is the only thing that keeps me from sweating. And I have come to realize that my body is fairly sensitive to temperature change, because I never cease to wake up just in time to look up and see the fan making its last glorious rounds. A motionless ceiling fan is the equivalent to the gavel dropping, as I am sentenced to another sleepless night.

my bed, covered by the mosquito net, and ceiling fan above

Now, most power outages so far have lasted anywhere from a few minutes to several hours. In these cases, I usually pass the time reading, playing games on my phone or, my personal favorite, showering: the only thing to do that does not involve sweating. However, over the Christmas break, we experienced a period of about 36 hours where 30 of them were blackout. In this case, drastic action had to be taken.

The power went out in the middle of the night, so by noon on the following day, it had been around 10 hours without power. Dennis, Patricia, Desmond and I came to two conclusions: we had to get out of the house, and soon, and the food in the refrigerator was in jeopardy of going bad. Coming to this conclusion, we did the only logical thing one could be expected to do in this situation: we had a binge eating session where we tried to consume all those foods most vulnerable to spoil, and then we went directly to the beach.

Going to the beach was a big deal. For one, Desmond is Ashanti: a very proud tribe from the center of Ghana. Not being near a large body of water, he never learned to swim, and is deathly afraid of the ocean. Dennis and Patricia do know how to swim, but do not seem too fond of it, and admit that they prefer swimming in pools. At this point, I had been in Accra over a month, and while we drive several miles on a road that hugs the shoreline on a weekly basis, I had not stepped foot on the beach.

We drove to a small cliff that overlooked a very nice beach, parked on the side of the road next to a few other cars, and made our way down the slope. The sand was unlike any I had ever walked on, with grains so fine that even after rinsing your hands off in the water, a few still resided in the lines of your palm. There were a few dozen people on the very spacious beach, so that it was not crowded at all. Boys playing soccer, two girls building sand castles, other children running and laughing in no particular direction while their parents chided them from blankets to slow down and remain farther from the water: everything was good. All thoughts of the power outage floated away, as I became thoroughly focused on enjoying the beach. We made camp a good 30 or 40 yards from the water, to make sure that Desmond was comfortable, and I put my towel down and made a bee-line for the water.

shot of the beach from atop the little cliff
people on the beach, some Accra hotels in the background

It was nice and warm, with some decent size whitecaps. Dennis and Patricia also chose to stay dry with Desmond, which seemed to be the general trend, as those on land vastly outnumbered those in the water. I immediately swam out past everyone else, and even though I was about 50 yards from the shore, the water was only up to my chest.

waves

For the next hour or so, I contented myself to play in the oncoming waves, jumping over some and diving under others. I returned to the blankets with well-pruned hands to dry off. Desmond and Patricia were returning from a walk, while Dennis decided to actually go in the water for a few minutes.

two little girls enjoying a day at the beach

When we finally made our way back to the car, the sun was about an hour from setting, and the sand was proving impossible to completely remove. We got back to the house to discover that the power was back on, and we promptly did a little dance, accompanied by some appropriate hooting and hollering. We were all riding high from our exciting day at the beach, and the prospect of being able to watch a movie seemed too good to be true.

In fact, it was. Not more than two hours later, the power went back off and stayed off for even longer than before. Oh well. Maybe we can make a habit of binge eating and swimming. But always waiting 30 minutes before going in the water, of course.

Edgar the Elephant in the Room and the C5

In the wake of the abject failure that was the Climate Change Summit in Copenhagen last month, I find myself observing my surroundings here in Ghana and wondering if any of the experts had observed Edgar, the big elephant in the room, while they were in Denmark.

Now, I am far from a climate change expert, when it comes to the intricacies of the negotiations. But, striving to be an informed citizen of Earth in the 21st century and watching week after week of the news coverage generated by the event, I like to think that I understand the key issues central to the debate. That being said, I welcome any and all corrections/additions/clarifications that would further enlighten myself and the good readers of this blog. From what I gather, developing countries don’t want to talk about any agreement that doesn’t involve maintaining the Kyoto Protocol. This is because the Kyoto Protocol – the old climate change agreement signed in 1997 in Kyoto, Japan – only applies to developed countries and doesn’t require any commitments or carbon abatement from developing nations. On the other side of the table are the developed countries, who won’t broach an agreement that doesn’t also rope in developing countries with legally binding requirements. Meanwhile, China continues to play both sides like a fiddle. Basically, there is a whole lot of finger pointing and no stepping up to the plate.

These are what I take to be the main points in the negotiation. I know (and hope) it is a lot more complicated than that, with some of the finer points being: what concessions to make legally binding, how to measure and enforce those commitments, etc. The summit gave lots of important people the opportunity to hear themselves talk, and after months and months of preparation, next to no progress was made. Leaders actually agreed not to let the mean global temperature rise by more than 2 degrees centigrade (about 3.6 degrees fahrenheit) from pre-industrial, which is about as asinine as agreeing that there should be 42% less wars over the next 67 years, while each country increases its military spending.

Meanwhile, Edgar the elephant was just hanging out, enjoying all of the free food and getting fatter. Edgar is the question of the capacity of developing countries to actually achieve any of the goals to which they might agree. This question was never addressed in a meaningful way. Instead, as they often do, rich countries tried to address it in the most superficial way possible: by creating a fund to throw more money at the problem. This time, they called it a fund to “help developing countries cope with the effects of climate change.” While negotiators remained fixated on who should be bound by what concessions, no one seemed to be talking about HOW developing countries would actually be able to achieve any of these said concessions. For me, having witnessed the C5© – Copenhagen Climate Change Convention Catastrophe (C5 is copywrited and comes with YMCA-style hand gestures to refer to it) – unfold from a developing country, Edgar remains the most important unaddressed issue of this entire debate.

Many of the proven interventions to mitigate and prevent climate change, like in health, involve behavior change of entire populations. And more than anything, these interventions require the political will for large-scale investments to increase public awareness hammered home over years and years. This is not a silver bullet vaccine that donors can just throw money at to buy more doses. This is condom usage. Think about how long tree huggers have been preaching about recycling in the western world. Meanwhile, the concept of recycling in Ghana is more of a myth. In many respects related to individual behaviors affecting climate change, the developing world is decades behind.

A few illustrations from a little over two months here:

- In my first week, I asked Patricia if we recycled; she just laughed. We have to pay a private waste management company to pick up our trash. That public service is almost non-existent. Most people just burn their trash in piles on the side of the road. Trash is everywhere, and Accra makes Manhattan look like Chicago (In case you missed it, that was a ZING to all you New Yorkers.).

- The first time I traveled downtown, I bought a bag of water to hydrate. (Purified water is sold in 500ml plastic bags here for about 4 cents: a really good deal. You bite off a tiny corner of the bag, tilt and squeeze.) I spent the next 7 hours looking for a trash can for the empty bag. I never found one.

- I’ve been to half a dozen conferences so far, some with over 100 participants, where they hand out an average of 20 sheets of paper per day per attendant. Not once have I encountered double-sided printing.

- The combination of terrible roads and an ever-increasing population is not a good equation for traffic in Accra. An even more important variable is car quality. Let’s just say that the average car here is a lemon, and the idea of having any sort of emissions standards in laughable. Sitting in Accra traffic with everyone’s clunker humming away and looking at the fumes slowly rising into the sky is downright depressing. I have yet to see a hybrid car. Not even the donor SUVs.

A typical vehicle on the road, spewing fumes into the air

- I saw on the local news the other day that some rural areas are running out of trees for firewood with which to cook. They interviewed one woman who had a gas stove in her house, but refused to use it in favor of burning wood. When asked why, she said because she was scared that turning it on would cause her house to explode.

- Last week I received a call from Ghana Immigration Services where they were processing my visa extension forms. They needed some more documents for my application, so I asked if I could send them in an email. “No, you need to print them out and bring them in person.” was the answer from the other end. “It takes over an hour for me to get there, so I’ll have to come tomorrow”, I said. “Are you sure there is no way I can email them to you? I have the forms on my computer, so I can get them to you right now.” “No, you need to bring hard copies.” “Do they need to be originals?” “No, photocopies are fine.” “Then why can’t I just send them to you? It’ll save me a trip, be quicker, and you can print them out there.” “No. You must bring them.” Accepting defeat, I gave up. Charles and I successfully sat in more traffic the next day, adding the completely unnecessary trip to our carbon footprint.

While these anecdotes can be amusing and comical to westerners, the serious impact they have on the world is no less real. Many of the aforementioned tidbits illustrate the behavioral nature of culturally-ingrained actions requiring change. But it is precisely these changes that take the most time. Trying to look on the brighter side, I can see several opportunities for policy initiatives. How about a government-run trash pick-up program that would create jobs while simultaneously cleaning up the country? Not every solution needs to be rocket science.

trash-filled drainage system lining a major road in Accra. Much-needed during the rainy season, these channels line most streets in Accra, and every one of them is riddled with garbage.

close-up of the same above

Outlining a climate change agreement is a means to an end, not the end in itself. Making an agreement for the agreement’s sake helps no one, especially one where developing countries have extremely limited capacity to achieve the goals set forth. The main question is not which countries or what levels, but rather HOW. Meanwhile, the U.S., China and others continue to act like children on the playground at recess after someone just fell off the slide and hurt themselves. The problem is that it’s the Planet that’s down for the count, and there is not a teacher around to regulate and figure out what happened. But that doesn’t stop the children from finger pointing. And that doesn’t help anyone notice Edgar the big elephant happily playing on the see-saw.

Dr. Alex Dodoo

So, I have been consciously avoiding talking about my work in Ghana and instead discussing everyday experiences about the people and the place that highlight cultural similarities and differences which I think people will find more interesting. I have mainly been doing this because who wants to read about what other people do at work? Honestly. I have also been doing this, because it would force me to use and explain A LOT of acronyms. And I hate acronyms. However, it seems like you are a fickle bunch; what used to entertain no longer does, and you want to know what I'm actually doing with my days. So, I thought I would ease into the work stuff with an introduction of my boss, Alex Dodoo, and a quick gist of what I’m doing. We can get into the weeds of global health and development in Ghana in later posts.

Alex is a pretty awesome guy, in most senses of the word. A pharmacist by training, he holds a PhD in Pharmacology from Kings College in the UK. And now, by his early 40s (I think), he is simultaneously: a lecturer at the University of Ghana Medical School and Korle Bu Teaching Hospital, the president of the Pharmaceutical Society of Ghana, the chairman of the Food and Drugs Board (Ghana’s FDA), and has just been the first African elected president of the International Society of Pharmacovigilance, amongst other things. Very articulate with a commanding presence, Alex can often be seen and heard on TV and radio programs here, informing the public on all things pharmacy and representing some of the many organizations to which he belongs.


poor quality picture of Alex from a google image search

In addition to his professional accolades, he is also one of the nicest guys you will ever meet. Knowing that I’m new in town and living with a pastor (because he's the one who made the arrangements), he has gone out of his way to invite me to parties and get-togethers with his closest friends and family: most of which have been great fun. I don’t want to get him in trouble, but let’s just say that he works VERY hard but is also intimately knowledgeable about how to have a good time.


Alex on our TV via a morning talk-show, discussing the H1N1 virus

I first met Alex through my previous job at the Center for Global Development, where he was a member of the working group we convened for a project on the immensely complex topic of drug resistance. A pharmacist with a passion for pharmacovigilance*, he was a great contributor to the work during my time there. Then, when I decided that I had done enough policy research in DC and wanted to get out into the field, he was one of the first ones I spoke to. And here I am.

I am working with the Pharmaceutical Society of Ghana (PSGH): a professional association consisting of every single registered pharmacist in the country. In developing countries where doctors are few and waiting rooms at hospitals are never-ending, pharmacists have a much greater role in the provision of health services than we think of them in the US. For better or worse, pharmacists are often the first health workers patients see, especially for certain common disease types like diarrhea and malaria, so they often have clinician duties on top of their drug dispensing ones.

a bow-tie clad Alex relaxing with friends at a party to which he invited me

In addition to representing all Ghanaian pharmacists in public and private sector matters, over the years, the PSGH has also run several public health projects: Hepatitis B vaccination campaigns, bed net distributions, public information programs on TV and radio, etc. PSGH’s mandate also includes running yearly mandatory continuing professional development (CPD) training modules to keep all members up to snuff on the latest developments in the profession. Put generally, my job with PSGH is to help them develop, fund and implement more of these public health projects and CPD trainings. I probably have the most experience in malaria, and since it is by far the number one disease in the country on most lists, Alex is very happy with me focusing on that. Put simply, he wants me to bring home the bacon in the form of donor funding. It’s the first explicitly results-based job I’ve ever had, so we’ll see how it goes. So far so good.

But that’s that, enough work talk for today and definitely enough acronyms.


*Pharmacovigilance (PV) is defined by WHO as “the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other possible drug‐related problems.” Such problems might include drug interactions, off‐label uses, and the presence of substandard or counterfeit products on the market, as well as reported lack of efficacy. In practice, it is mainly two-fold: monitoring patients’ relationships with the drugs they consume and surveillance of pharmaceutical quality of those products on the shelves.

All Dennis Wants for Christmas...

is a goat. Seriously, he never came right out and asked for one, but for the couple weeks leading up to Christmas, he was laying the hints down pretty thick. “Oh, how nice it would be to have a goat over the holidays!” “We usually get a goat for Christmas, but I’m not sure if we’ll be able to this year.”

random goats on the side of the road: as common as as the grass they eat

After hearing these subtle pleas for a few weeks, I got the hint. And even though I have gotten to know Dennis and Patricia fairly well in the month and a half I have lived with them, I still had absolutely no idea what to get them in exchange for all their kindness and generosity. The goat was a win-win for everyone involved…except the goat. Plus, it would mean that I would get to share in all the stews and kabobs Patricia would make from it.

So, about a week before Christmas, after another one of Dennis’ hints, I asked him how much a goat was. His answer: maybe 70 or 80 cedis ($50-$60). Then, I told him my plan: we’d go 50-50 on it. He thought about it for a minute, and then a big smile came across his face, and he said “Alright!” He was in good spirits for the next few days, shopping around for the best deal. He called some friends in more rural places to see how much they were selling for up there (Accra is on the southern coast, so when I refer to rural places in Ghana, I will probably use “up there.”) and contemplate transportation logistics, and we went around to a few of the sellers in town. It seemed many Ghanaians also had the same goat idea, and we quickly found out that there was a holiday premium on our furry, horned friends. But all that meant was that we would have to pay a little bit more or sacrifice a little on size.

A few days before Christmas, Dennis came home and declared that he had found our goat from one of the sellers down the road and that he and I would be going to pick it up the next day. So, the day came, and we went.

****EXCLAIMER****It gets a little gross after this****EXCLAIMER***

As we drove to the place, Dennis explained to me that we had to pay an extra 10 cedis for them to do the dirty work (killing, burning the hair off, disemboweling, etc.). He said that, according to the pre-arranged time for us to pick it up (noon) it should all be done by now (2:30), and we could just grab it and go. But, Ghana being Ghana, of course it was not done yet. We pulled over and parked on the side of the road about 30 yards before a roundabout (rotary) whose center was being used as a makeshift pen, with 3 or 4 guys guarding/herding the dozen or so goats. Dennis explained that yesterday, when he came buy there were about 3 dozen left: apparently they were quick sellers.

Goats of many sizes, shapes and colors in the center of the rotary, guarded but some guys

We crossed the road to the shack right before the rotary, which was where the dirty work was being done. In front of the shack was a dead goat, skinned and de-furred, lying in an empty bucket. From inside the shack, the din of loud, ominous chopping rent the air for all around. The guy from inside saw us approaching and came outside to meet us. He was a huge man in height and girth, probably about 6’5, wearing a sleeveless shirt drenched in sweat. Large burn scars running up the length of his right arm from shoulder to wrist. He explained that he was running a little late, but that he would start the disemboweling process now, motioning to the goat in the bucket. GREAT!

Luckily, there was an empty bench nearby for Dennis and me to have a front-row view (slight sarcasm). For the sake of time and sick stomachs, I will not describe the process in detail, but rather only use a few key words and let you know that I do have pictures, so, if you’re interested, inquire within:

saw, head, off, slit, intestines, innards, wash, drain, wash, drain, chop, chop, chop

We left half an hour later as Dennis happily carried a black bag full of what had become of our goat. His step was so airy that you would have never guessed that the bag was about 50 pounds. When we got home, Dennis got right down to the business of chopping it into even smaller pieces. Everyone was very pleased with the proceedings, and I had seen enough dead goat to last me a lifetime, so I left the kitchen. At the writing of this, I can say that Patricia has certainly put the sacrificed animal to the good use of very tasty stews, meat pies and more. All in all, it was one of my more successful Christmas gifts, if rather unconventional.

Dennis happily chopping up the goat in the kitchen