I’ll miss…

Julia and I, having completed the distribution, are heading home! Inspired by Vilas’s recent post, I thought I’d list the things I’ll miss most about Ghana (in no particular order).

Coke. I will miss African Coke made with sugar cane and served in glass bottles. Minerals, as soft drinks are ironically called in Ghana, just taste better here. Part of it is the increased refreshingness that comes with any cold beverage when consumed under the equatorial sun and some of it is the sugar cane used instead of corn syrup. Did I mention that a Coke on the street is about 35 cents?

The children. Our work took us to very rural farming villages in the Eastern Region that are far away from the cosmopolitan city centers. I’ll miss the little kids that sprinted towards our car as we pass screaming “obruni” and waving their hands violently back and forth. I’ll miss waving back. I’ll miss trying to communicate with them in my horrible Ghanaian English accent. And I’ll miss their enormous, kind, innocent smiles.

Fanmilk. Without going into too much detail, Fanmilk is the greatest company is Ghana. They produce a series of frozen iced snacks that are sold largely from bicycles with a cooler chest above the front tire and a meat pie display case over the back. Somehow these things stay frozen rock solid and are distributed everywhere. There are three varieties: Fanice (very creamy vanilla ice cream), Fanyogo (strawberry yogurt – the healthy choice), and Fanchoco (more like iced chocolate milk than ice cream). All varieties come in a sealed plastic bag. You bite the corner off and enjoy. I’ll miss assessing my mood and going with the iced treat that bests fits. I’m in a Fanchoco mood right now.

The taxi drivers. I’ve come to really enjoy the whole taxi experience in Ghana over the last two months. At first I hated it because I hate taxis in the USA. Now, I enjoy the whole event of taking a taxi from the initial mandatory bargaining phase to the information phase where I pose 1,000 questions about Ghana culture or whatever. Most of the stuff I learned about Ghanaian politics, the education system, and the armed forces came from conversations with taxi drivers.

Waakye. Oh, waakye. You broke me after I had you in a tro-tro station in Asesewa but I still love you. I’ll miss the perfect combination of spaghetti noodles, red beans and rice, chicken sauce, pepper, cole slaw, fried plantain, and corn flour. So tasty.

Radio. I listened to the radio in Ghana much more than I watched Ghanaian TV.  I’ll miss failing to understand what’s being said in Twi or pigeon English despite serious concentration. I’ll miss the news reports on BCC World Service Africa. Most importantly, I’ll miss the super tacky radio branding call signs and hokey sound effects that the DJs couldn’t resist playing over their reggae tracks. PS today I heard a song whose chorus was, “America, America. Break the neck of this apartheid.”

Feeling special. Perhaps this is best for last. As a white, male American, I almost never feel in the minority. I’ll miss feeling different and special in Ghana, instantly worthy of conversation because of how I look. Exotic. It’s pretty shallow, but it’s the truth.

Distribution!

Friday and Saturday we ran five distributions and gave away around 2,000 free bed nets to seven communities in rural Ghana!

It feels so great to have completed this vital part of our project and so rewarding too. Most of the people who received nets are poor farmers who live in rudimentary housing, collect water from a stream, and have no access to electricity. Many suffer from malaria. In fact, just other day Julia and I met a six month old baby who had a bad case.

The distribution days were crazy long from 6am until 6pm non-stop. We unpacked every net, cut the tag to identify it as a TAMTAM net, and repacked and stapled it…for about 2,000 nets. Then we distributed the nets from five points. We called the name of the compound head who was supposed to receive the nets and waited for either the head to come up or, as often happened, a representative of the head. Then we checked if they knew basic demographic information on the household, like the number of adults and children, and cross-referenced their responses with information collected during the pre-registration. For the most part, this method worked smoothly. The villagers waiting for their nets were not afraid to object if someone tried to cheat the system and most of the checks worked.

Things did go awry, though. Murphy’s (or Sod’s, if you’re British) Law, I guess. In some cases, it looks like the initial registration numbers were off. In one case, the community health volunteer had a difficult time collecting the pre-registration data and that whole community was a bit off. Some people who did everything they were supposed to were not on the net lists because the CHV didn’t submit their pre-registration form. The whole experience gave me a better appreciation for how important CHVs are to a project like this. One volunteer can affect an entire distribution pretty quickly. In pretty much every distribution there was disenchantment at the end of the distribution. People from other communities, who unfortunately were not covered in the distribution, showed up and were angry to not receive a net. I suspect part of this problem stems from the fact that most interventions in places like these are operated on a first come first serve basis and not by community. We did anticipate this and made clear to all that only those registered would receive a net. Only so much you can do. It was hard to leave people without a net who had waited all day.

We spent today recuperating and we’re off tomorrow for a day trip to train the volunteers on the hang-up component of the study.

Check out many more photos on Facebook!

Ghanaian Ingenuity

What is going on here? That is a LPG (liquified petroleum gas) tank that has been fitted in the trunk of a taxi in Ghana. I just came across this yesterday in the taxi that took us into the field and back to collect our pre-registration forms. (The forms were great, by the way, and we spent the better part of last night and this morning entering the data into a spreadsheet for our upcoming distribution and randomized hang-up). LPG emits less carbon dioxide than petrol, much less nitrous oxide than diesel, and produces zero particulate emissions. It’s also better for engines because it burns more cleanly than the alternatives. Fill-up works exactly the same as when using petrol and takes about the same amount of time. It’s certainly a viable auto fuel in Ghana, where there are LPG stations in every major town.

Having discovered this alternative fuel source, I’ve been asking every taxi driver I’ve encountered about what they are using and why. I’ve surveyed about a dozen drivers and here’s what I’ve found:

1. LPG-users like LPG because it is cheaper that petrol. Both LPG and petrol prices are fixed by the government, LPG at 0.50 cedi a litre and petrol at 1.16 cedi.
2. Petrol-users like petrol because there are LPG shortages often (lasting up to three weeks) which can result in work-days missed and increased price.
3. Diesel taxis are not that common and seem to be the more conservative choice – efficient, reliable, etc.
4. Nobody gives a hoot about the environmental impact of their respective fuel.

One taxi driver told me that the recent trend to home-install LPG tanks in taxis occurred when Asian imports starting coming in that were built to be powered on LPG. The drivers saw this, recognized that they could use the same LPG in their cars that was universally available for their cooking stoves, and figured out a home-grown solution. According to one driver I spoke to, the tanks are mostly coming from other countries, though there is one company in Ghana that builds the steel canisters required for safe LPG storage in a car. Apparently, car manufactures sometimes ship LPG cars to countries that do not have enough demand for LPG vehicles. These LPG cars are converted into petrol cars before they are sold and the LPG surplus tanks eventually find their way to places like Ghana.

LPG is much cheaper than petrol in Ghana, about 0.50 cedi versus 1.16 cedi. The prices are fixed by the government. No doubt, this is a main driver for the recent LPG phenomenon. The government, however, doesn’t like that LPG is being used to power cars and often claims that this is the cause of shortages. (Taxi drivers using LPG disagree, naturally.) While I am still a little unsure of how the prices are set, I can see that it would be very difficult for the government to find a politically tolerable price for LPG because it will affect the entire population using cooking gas as well as the taxi drivers. Petrol is a lot easier to set a price for because the poorest of the poor do not have vehicles. It wouldn’t surprise me if the government outlaws LPG-use in vehicles (or just taxis) in the future – perhaps just adding LPG tanks to the list of items that police officers search for at checkpoints. Of course, a dash will take care of any indiscretion.

I haven’t been able to get a good estimate of the proportion of cars, or even just taxis, that are using petrol, LPG, and diesel. One LPG-user told me the majority of taxis use LPG, a petrol-user told me about 10% of taxis use LPG. So it goes in a country with very few reliable statistics. I can say that I personally have seen at least 10 taxis with home-fitted LPG tanks in their trunks.

Community Health Volunteer Training

Friday we spent the day training community health volunteers (CHVs) on how to administer our pre-registration survey. We have seven CHVs working with us in six communities. In sum, we are covering somewhere between 4,000 – 8,000 people but we don’t really have any idea how large the communities are. We don’t have baseline data and the Ghana population estimates seem to be pretty far off. We had the CHVs count the number of households and got estimates but there’s no telling if they are accurate either. It’s sort of a big deal because we need to have a certain sized sample to have enough statistical power and we also need to know how many nets to buy to achieve universal coverage.

Traveling in style

Anyway, long story short, the pre-registration survey will hopefully answer all these questions. We are collecting information on the number of households, the number of people in each household, and the number of existing nets in the household. All this is going on right now. We trained the CHVs on friday and had them conduct the door-to-door registration over the weekend and today. We are going out to the Eastern Region tomorrow morning (leaving at 6am!) for a day trip to collect the turned-in registration forms and enter them into our database. We will then be able to quickly calculate how many nets we need to purchase for our distributions friday and saturday.

Making fufu

On the lighter side, Julia and I got to spend some time hanging out with a family and learn how to many fufu.

Check out more photos on my facebook page. Here’s a link to them!

Ahhhhh French champagne

The peanuts are good in Ghana. They are a little smaller and more crunchy than in the US. They are also really cheap. There’s a brand here called Becky Queen that’s pretty tasty. We picked up a large container of Becky Queen peanuts at an ex-pat supermarket last week. When we got home I realized that, while there was a Becky Queen label plastered on to the bottle, there was a Paul Masson wine cap taped on to the top. I paused. The strange bottle that I took to be interesting Ghanaian marketing in the store looked remarkably like a wine caraffe. Yup, we were eating peanuts out of an old Paul Masson wine bottle. I wonder where the bottle came from and how it got to a Ghana supermarket. Come to think of it, I wonder where the peanuts came from too!

Paul Masson peanut line, anyone?

Of course, as always happens upon any contact with “Paul Masson,” I immediately thought of the incredible Orson Welles Paul Masson outtakes.

Shopping at Makola

I’m a big fan of Makola Market. At first experience it was frankly insane. It’s a giant, sprawling, packed market that spans many blocks. I’ve come to like it though. I have no idea where anything is, where I am at any moment, or what the heck is going on. I just sort of wander around, asking people where to find things, being passed on from person to person, shaking hands, smiling, avoiding knocking anything (or anyone) over. It feels like I’m a human pinball – just bouncing around. But it’s so awesome. Everything is somewhere there, you just have to find it. It’s the ultimate scavenger hunting ground.

Yesterday, Julia and I went with the aim of buying some fabric for her to make dresses/us to make some pillow cases for our place. I picked up two awesome items of my own:

1) I’ve seen this bag around Accra. It’s a Mickey and Minnie bag. So random, I know. Take some time and read the captions. My favorite is “593 Exciting Prizes.” Why 593!? I have no idea. I plan on framing this like a painting and putting it on our wall.

593 prizes!

2) A little radio. 5 cedis. Best purchase I’ve made in Ghana. I can’t believe I didn’t think of this before. I plan on carrying a radio with me to every country I visit from now on. Besides my favorite station, BBC World Service, I’ve been listening to a random French station (probably from Lome), and a number of Accra stations. The Ghana stations are half english – half twi and I can only understand about 25% of what I hear, but it’s a great way to experience Ghana. The jokes, the ways of showing excitement, not to mention the news and topical stories, combine to give a good picture of what is important to Ghanaian society.

La radio

Field Work

So we’ve selected our site to be in a collection of communities near Asesewa in Eastern Region. Yesterday, we went out to see our community partner, an organization called KLO Drivers Alliance, and meet some of the community health volunteers. It was a 15 hr day with 8 hrs of travel, but very interesting. The rural communities are in a very pleasant area, lush with trees and at a somewhat higher elevation than Accra. It was like a day in the country.

I seemed to only catch transportation photos. We first took a 2.5 hr tro-tro from Accra to Koforidua at 6:30am. Then we transferred to a shared taxi, which we entirely commandeered, to take us on the one hour trip to Asesewa. In Asesewa, we hired a taxi to take us down the very rough dirt road to the community office. That road looks like it does bad things to the cars that drive on it.

Julia and I got to take a long walk through one of the nearby communities with two of the community health volunteers to estimate the number of people in each compound. The community is comprised of about 85 individual compounds that are separated by narrow paths through the dense forest. It’s really nice, actually. Each compound is tucked away in its own clearing surrounded by fruit and vegetable trees/bushes. It’s a farming community so the requisite sheep, goats, and chickens wander around making a ruckus as well. Nice spots. We talked to about 20 homes. The average size was around 6-7 people and virtually none of them (2) had a mosquito net. It looks like we will do a lot of good here.

At one home, we were very kindly offered some boiled corn. We accepted, as we didn’t want to be rude. We saw where the water comes from, though. Little kids fill large tubs at a dirty stream and then walk them up to the compounds on their heads. Given our recent spat with what appears to have been a bacterial infection (Cipro cleared it up), and the sad fact that even boiling water doesn’t kill all bacterial, we weren’t really interested in eating this corn. Julia threw hers in the bushes and promptly said she liked it so much she already finished. I went a more conservative route, took three bites (a rough estimate of the maximum exposure to bacterial that I felt I could withstand at that moment), and offered it to the community health volunteers after explaining that we white people had weak stomaches or something like that. It worked, I think. At least we didn’t get sick!

Rough roads

A typical tro-tro. You can be sure it will be packed because they won't leave unless it's full!

This is the most beat up car I've ever seen and it's still running

Then we took the same beat up taxi back...with 7 people packed in.

Back in action

I know it’s been almost a week since I wrote a post. I wish I could say that Julia and I have been busy having a blast traveling and the like but, sadly, I cannot. We spent the better part of the last week housebound, well actually bedbound, sleeping off some food poisoning. I didn’t eat for two or three days and went on Cipro from the getgo. At first I was sure it was food poisoning. Then I was thinking that it might be malaria after I had a mid-level fever for a couple days that didn’t subside with the Cipro. Then I got a rapid diagnostic test for malaria at a pharmacy to be sure. It was negative, but there was a chance my Malarone was cutting the malaria symptoms and parasite load so nobody could be sure. Then I stopped Cipro, had a giant meal, and came to the conclusion the most of the symptoms that I was having (including the headache) were probably the result of starvation rather than any sickness.  Now I’m getting my energy back and more restless than tired after spending a week in the house.

Not much happened the last few weeks. Two of our team of six went home this week to the States because one of them wasn’t feeling well. And then there were four. As a result, we cut one of our sites for the study so that we would have enough resources. Hopefully we will be able to do one site really well.

We are still waiting for Ghana IRB approval…things take a long time in Africa.

Perhaps now is as good a time as any to explain what we’re studying: we’re doing a randomized controlled trial with a control group and three intervention groups. There are two stages. The first stage looks at the impact of incentives to reveal existing mosquito nets. The second stage looks at leakage of nets over time and the impact of using community health volunteers to hang up a net.

During the first stage we will have community health volunteers conduct a door-to-door registration of compounds in the community. They will ask for information on existing bednets, sleeping spaces, malaria incidence, etc. The total popolation is randomly broken up into two groups – one group is offered a bar of soap for every good net they declare when asked during registration, the other group is receives no offer of soap but is asked the same question. We will look to see if more nets are declared in the group that is offered soap.

The second stage is a little more complicated and looks to address leakage of nets that occurs after a point distribution as well as the impact of doing a door-to-door hang-up campaign after a point distribution. There will be a point distribution of nets based on the information received in the registration followed by door-to-door hang up of the received nets. There are four groups to which compounds are randomly assigned. Group one receives the nets and then has no hang-up; this is the control. Group two receives the nets and then has a community health volunteer show up on day 3 to hangup the nets. Group two is the same but the volunteer comes on day 7, group three on day 14. Then after one month, a survey is conducted to see how many nets that were given away are hanging, among other things. We are looking to see if there is a difference between the groups.

The issues we are studying were chosen after many meetings with administrators in the Ghana government, USAID, and NGOs working on bednet distribution. We are attempting to provide these actors with information to improve future distributions of nets…that is, if we get IRB approval!

A day in Accra…with a point and shoot

We started the day talking to Joyce and took a couple of snapshots with her. More on these later.

Then we went to Osu to look for some fabric for Julia to make a dress and for some pillows. We tried a big shop and didn’t see anything we liked so we stepped into a fabric stand outside, where two girls were playing mankala. We bought two types of kente print, 6 yards total, for 4 cedi a yard. Of course, Jules tried on some of the pre-made dresses to the delight of the shopkeepers. One of the girls complained that her skin is too dark. I informed her that she is crazy and that, if anything, the beautiful, colorful fabrics looked much better on her black skin than on Julia’s white skin. I hope Julia wasn’t too insulted.

Then we stopped into a supermarket/home goods store for some groceries. Food is super expensive in Accra. Even though we try to buy as much as possible from stands (as much as possible without getting too sick), the costs are high. We came across some cribs with built-in mosquito netting. Awesome!

We made a trip out to University of Ghana, Legon and looked in the very impressive bookstore. Dad, I know you’re jealous. There was a neat chalkboard outside marking all the new arrivals. Julia picked up a little red book of a lecture given by a professor at University of Ghana on foreign development aid. Is it a Trojan horse? I’ll let you know after I read the lecture.

Finally, we stopped at the mall and decided to have prints made of the photos with Joyce. She’s going on vacation soon and we wanted to give her a gift. We stopped at Pizza Inn for some lunch.

Obama Biscuits – no explanation needed.

Today it was hot. So hot that the tar in the street is melting. Not the bubbling melting I used to see in Maryland when playing on the street at my grandparents either. This is more like a mini river of melted tar, flowing downhill and pooling. It’s hot.

Oh yea. Hi. I’m Mat.

I got a new camera!

You might remember that my camera died after being exposed to sewage runoff in an open drain in Accra about a month ago. Today, I received its replacement! A Canon SD940IS digital point and shoot.

I wanted a camera with HD video and a longer zoom. This guy has a 2.7″ screen, HD video, and a 4x optical zoom. I haven’t taken it out yet but will update with photo ASAP.