Slum Survey of Accra -- A day in Yam Market

Banku and Okuru Stew at Chop Bar near the Office

Making Light Soup at the Chop Bar near the Office

Making Waakye near the Office

Making Fufu at the Chop Bar near the Office

A Photo Update

I've been sick the past couple of days -- feeling better now -- but as a consequence, I haven't done my typical weekend blog update and instead have completely vegged out and burned through almost the entire first season of Heros on DVD while intermittently napping. Now I'm trying to catch up on some work.

Because I've been negligent in posting lately, here are some photos to wet some appetites until I have a chance to write more:

Laundry Day: I wash my laundry by hand once a week. Typically, I start early in the morning and it is sunny out and by the time I've finished soaking and scrubbing it's thundering and my clothes get a free rinse cycle on the line.

On the note of clothes, I've had some clothes made for me by a seamstress near my office at work. This is Linda who sews the clothes with her partner, and these are 2 of my outfits:

Another Cooking Expedition: This time it was banku with fried fish and tomato salsa. I have to admit, this is probably my least favorite Ghanaian dish. Actually, it is my least favorite dish. Unfortunately, it's what the area I am living in likes to eat the most. Adoza, a friend of James' who stayed with us for 2 weeks (in the yellow shirt) enjoyed this dish and this meal was his inspiration.

Banku is a dough made from Cassava and Plantain flours, some of which are fermented. You mix with water and cook on the stove stirring and beating until it thickens. Then you keep stirring it. Eventually, when it's super-thick, you form it into balls and eat them with a sauce using your fingers.

Barack Obama, pt 1

Barack Obama arrives on Friday, July 10th for his first "official" visit to Africa. While Obama was in Egypt just last month, the United States does not consider Egypt to be politically part of Africa rather considers it to be the Middle East. So while Africans are a little confused, officially, this is the first African visit. Everyone in Ghana is quite excited to host another American President. People still talk about when Bill Clinton visited Ghana in 1998 (picture).

Over the past several weeks an increasing number of posters featuring Barack Obama, Michelle Obama and Ghanaian president John Atta Mills have appeared in public places throughout Accra. The picture shown here was taken infront of Independence Square, a large outdoor ampitheater, in downtown Accra.

This radio announcement has been playing for the past couple of weeks on every major radio station:

"First black president of the United States of America, you have become a shining star, and despite the height of your achievement you are still proud to be called a black man. Barack Obama is coming home. He is coming to Ghana, Gold Coast, the center of the world."

This is quite a popular song as well:
Barack Obama reggae by a Ghanaian radio personality, Blakk Rasta:
Video

Lyrics:

Intro
Yao! Rasta, unu hear sey some blackman say im waan turn American president?
Im think sey, dem a go skin up dem teeth and watch im?

Chorus
Mama mama
Com mek wi talk o
Com mek wi talk about Barack Obama
Papa! Papa!
Com make wi talk o
Com make wi talk about Barack Obama
Barack Barack, Barack Obama (2x)

Stanza (verse) 1
Originally steping out-a Kenya Africa
Adopted into the cold woodlands of America
Trust me Iyah,
Dem youth defy every order an' turn senator
Rat-Rat-Rat-Rat!
De gunshot of hate continue fi echo in-a every corner
How com blackman become president in a money-mecca?
Barack beware! Barack beware! Barack beware!
before dem turn ya name into Barack Osama
In a dis ya time,judgement a com without waata
For legalising abortion in a america,a-fyah! fyah!

Repeat Chorus

Stanza (verse) 2
9-11 was de beginning of satan endtime
Baptising black americans in a bitter juice of lime
Making sure no black man in a america will see his prime
In a dis ya time a black american president a great sign
Too long dem disrespect blacks and africans combined
pon black peoples flesh and blood,de kuklax clan love fi dine
Watch out Barack Obama and intensify ya power turbine
Or else breddren Obama,your dark days will never sublime

Chorus

Singing verse
Precious sheep grazing in their territory
(brother Barack watch out)
Some don't love you
They only faking it
(brother Barack watch out)
Many righteous ones been sacrificed by this very same system
As you keep the fire burning,black president

Stanza (verse) 3
Yahman! yahman! yahman!
"God bless america" the idiot bwoy always say
When de bombs and weapons fly over innocent people head
Oh Obama,me neva hear you talk 'bout africa yet
Or is it a nice way of swerving dem in a ya capaign?
Mr Obama,bring dis poly-tricks money to africa andkeep de poverty at bay
Too long black people keep nyaming up horse hay
Wake up Obama and don't join de band wagon of de gay
Beware Obama!Watch out Obama!Look around you
the people dem show you nuff smile
but dis smile dem a fake! fake! fake! fake smile dem!
Watch out Obama,a-fake!

Rain

Teshie is flooded this morning. It rained all night last night and is still raining now. The drainage system is completely over burdened and there are rivers more or less running over the roads. We tried to go to work, but it seems as if no one is travelling at the moment. The radio says that this is the "tip of the iceberg" and that we should expect to get more rain during the day today.

I'm working from home this morning, and I hope that travel conditions improve enough to make it into town for a meeting this afternoon. I now have a much greater appreciation for why it is schools close down when it rains; it is dangerous! While I'm sure the dedicated few are trying to travel, I can't help but think about the back roads we take on the tro-tros, how much flooding there is just after a normal rainstorm, and how bad they must be this morning. I can't imagine many of them are passable via the normal routes.

I'm hoping the flooding isn't too bad elsewhere and that the damage is kept to a minimum. A few weeks ago there were heavy rains and floods in Kaneshie (another part of Accra) that killed several people and caused millions of cedis worth of damage [news article]. It isn't that the rains are so great, rather it is because the drainage systems are so poorly maintained that these problems arise and are of such a great magnitude. Refuse and human wastes are routinely dumped into drainage systems in parts of Accra and with the rains silt, soil, rocks, and clay are washed into the ditches gradually clogging the system. Problems with the drainage systems and misuse of drainage systems are responsible for ourbreaks of cholera and malaria in Accra.

With that said, off to work with me. And, for good measure, I'll join the little kid behind our house in his singing: "Rain, rain, go away, come again another day!"

Just Another Monday

Left the office at 3:10 pm. Walked through the house door at 5:28 pm. 45 minutes of this time was spent waiting for a shared taxi (an experiment not to be repeated), the remaining 1 hour 33 minutes were spent in the luxury of a drop taxi which was, if I may say so, well worth the additional money.

Observations along the way:

Aptly named, Beach Road is the single road that connects Accra and Teshie by running along the coast of the Atlantic Ocean. While the view of the ocean is amazing – the ocean itself is not more than 100 yards from the road at several points – there are many other sights, smells and sounds to be experienced along this road. There is much time to witness your senses on Beach Road as this road is notorious for its traffic caused both by the poor condition of the asphalt and by the intention to widen the road which has turned the 4 lane road into 2 lanes, one going east and one going west with no evidence of any progress on the expansion.

Smells: First, you’ll notice the smell of petro. Unlike the clean, relatively odorless burning of gasoline in the states, cars here emit a heavy, bitter stench that fills your nose, lungs and dries out your eyes. While you begin to ignore the scent after some time, every so often you’ll get a whiff so strong it brings you back to awareness. Then there is the burning of trash. The closer the road draws to the ocean the scent of the sea you expect is replaced by the stench of burning trash on the beach. More pleasantly, depending on the time of day, if you’re lucky, as you go through the townships you’ll smell grilled corn, plantains and meats.

Sounds: There is the music from your tro-tro or cab advancing from one song to the next, taunting your vehicle which must oblige the much slower and mundane beat of traffic. On Beach Road I have heard everything from rap songs about cybersex to reggae welcoming Barack Obama. And if your vehicle has opted out of musical entertainment (perhaps it has no dashboard upon which to mount a radio…), you’ll be fortunate if your car stops near to but not directly in front of the pickup truck that has been re-fitted with a cage and speaker stacks and blares music. It parks every day in the same spot, and if you happen to enjoy the music, there are plenty of young men eager to sell you a copy of that CD or any other CD you might desire.

Shopping: Not only can you buy CDs on Beach Road, you could nearly do your grocery shopping! In the late morning, a giant truck pulls up loaded with men and women and their wares and during the day the spread out over a 1-2 mile stretch of the road waiting for the traffic to grow denser. Once the traffic is stop and go, they walk in between and on either side of the lanes of cars up and down the street carrying their goods on their heads, in their hands, or, in the case of the “fan products” (read: icecream) man, pulling them behind you on a bicycle. There is a consistent and interesting gender segregation in who sells what products, and the breakdown looks something like the following:

MEN
- Apples
- Fan products (icecream in little sachets)
- Windshield wipers
- Toilet Paper
- Steering wheel covers
- Yogurt drinks
- Magazines
- Belts
- Stuffed animals and miniature flags
- Cloth
- CDs and DVDs
- Rolls and Bread
- Toy trucks and other odd, plastic toys

WOMEN
- Donuts
- Cookies
- Crackers
- Chewing sticks (used by some in lieu of toothpaste and brush)
- Umbrellas
- Plantain Chips
- Nuts
- Fried dough balls (carried in a clear, glass box on their heads)
- Limes
- Bananas

MEN & WOMEN
- Grapes
- Phone credits
- Water sachets
- Chocolate
- Miscellaneous bath supplies and home products

The drive itself has the chaos of a bumper car driving rink only with drivers who have no desire to hit other drivers, just to cut them off. Cars will try zooming around off of the paved road through hazards to advance through the traffic, and motorbikes will ride in between two lanes of cars where the street sellers stand. They come rushing forward beeping their horns constantly as if to shout “I AM HERE… I AM HERE…” It’s a fairly chaotic ride with really 2 distinct speeds: stop and GoGoGoGoGO!! More often than I or any government official knows, cabs get into fender benders. It is required that you have insurance on your vehicle, but because the police are so unreliable in their response time and because the burden falls 100% on the driver to make sure the incident is properly handled by both the police and the offenders insurance company, most accidents are never reported. It simply takes too much time to handle which equates to loss of income, which most cab drivers can’t afford.

While there are a wide variety of cars on the road, quite ubiquitous are Toyotas, Suzukis, BMWs, Tatas, and Ford vans. The cabs themselves are all uniform in color and comprise about half of the traffic on the road. On their back windshields they often have stickers reading things like “Blessing,” “Believers,” “BigSo,” “Whatever,” “Think Big,” and “LeTs.” The tro-tros more often have big sticker-pictures on their back windows. Some common stickers are pictures of a basketball and hoop and an eagle swooping down to grab his prey.

After passing through the strip of truly stop and go traffic during which time to the right of the road is the ocean and to the left the Ghana military academy and training school, you enter the township of Teshie. Here the sights change quite a bit depending on the time of day. In the afternoon, children are all walking home from school. Those who attend state schools wear brown bottoms and orange tops. Those attending private schools have a variety of uniforms. It was recently mandated in Ghana that children must attend school until the age of 16. Overwhelmingly this appears to be the case, but there is no enforcement of this policy and so much truancy exists.

In the township, goats and chickens roam the streets. This time of year, both goats and chickens have babies following them around. Children are sweeping the ground outside of little shops with bundles of sticks made into a short broom. Women nurse their babies and begin to prepare dinner either for their families or for selling by candle light on the street. If it has recently rained, you will find young boys in the drainage system shoveling out silt and sludge carried into the drains by the recent storm. One look at either side of the concrete ditch tells you this is a futile exercise as all it takes is 10 minutes of rain to undo all of their work.

Another common sight as you drive is men peeing. There are a few public toilets, and some homes have their own toilets, but there appears to be a “pee-freely” policy in place such that on nearly any wall or in any corner you might just happen to see a man taking care of business. I think women are a bit more discreet about their process, but children have no shame what so ever and will drop their trousers on the street or over a drainage ditch to do what they need.

Shops here are typically a free-standing 10 x 10 corrugated steel box that, when closed, has no windows. These are often put up on rocks to let the water run beneath them. Companies provide paint and some payment to shop owners willing to paint their stores in the company color and put the company’s logo on the building. Because of this, the streets are dotted and at times lined with these box stores painted in red and white (Vodafone) or hot pink and turquoise (Zain, another cellular provider). The signs for stores often have pictures of the foods or services they are selling out front. These boxes contain hairdressers, convenience stores, pharmacies, seamstresses, and other trinket sellers.

Turning off the main road and into my neighborhood, a suburb of Accra that was laid out some years ago in the fashion of a grid, the density of shops and sellers declines, but shops do not disappear as they would in a residential community in the US. If there are zoning ordinances that dictate where food and other sundries can be sold, I haven’t yet discovered a rhyme or reason to its issuance. Every now and then you’ll find a box store or other venue with red spray paint “REMOVE BY XX/XX/XX BY AMA” meaning the Accra Metropolitan Authority dictates you cannot have your stall there. However, more often than not, the stores are still operating despite the paint, or they are simply closed up but still standing.

Finally, 2 hours and 18 minutes after leaving work, I step out of a shared taxi, walk a block home, and collapse exhausted from the journey!

(pictures to follow)

Holiday Time

July 1^st is a holiday here in Ghana; it is Republic Day. While no one has been able to explain the significance of Republic Day, what it means practically is that most people did not work today. Sam and I also decided to take a holiday, telling ourselves: “When in Rome… “ I could not be more pleased by the results of my holiday had I planned them in advance!

Late Tuesday night a caravan arrived in our compound from the North of Ghana carrying with it a Scottish pharmacist and founder of Let Us Shine School for Girls (Fiona), a doctor (Mary), a teacher (Nell), and a journalist (Hannah) all of whom volunteered at Let Us Shine this past month. Two students from the school, Mercia and Naomi, ages 15 and 14 respectively, travelled to Accra with the volunteers in order to visit an eye clinic in the city. Mercia needs glasses and Naomi was beaten as a child and, as a result, is blind in one eye (truthfully, she was caned so badly the eye popped out and was put back in place by a witch doctor…); Fiona is hoping there may be something that can be done to restore the girl’s sight.

We were expecting the return of this group, some of whom left for the school just shortly after Sam and I arrived in Ghana. Fiona is how we came to find the house in which we live – she is married to a Ghanaian, Mawena, who has twin brothers (James and John) who run a volunteer company and have spare rooms to let in their house. We found out about the rooms because Fiona is from the same small town in Scotland that our Bulgarian supervisor’s Scottish boyfriend is from… it’s a small world! To the point, Fiona and Mawena have been in Ghana for 2 weeks and are heading back to Scotland with the volunteers tonight.

I started my holiday off by preparing breakfast for all the newcomers (and the regulars to the house—there is always someone dropping by to say hello or to sleep on the couch for a night). Fiona, Mary, Nell, Hannah and the girls were famished because the journey from the north took much longer than had been anticipated, and no one had eaten the night before. We had a feast of wheat toast, hard-boiled eggs, watermelon, jam and groundnut paste (peanut butter). It was delightful, deeply appreciated, and enjoyed by all. I guess I do have some good old Midwestern blood in me if I can’t stand the thought of more than 4 people in a room without there being food!

The two girls, Mercia and Naomi have never left their village before this trip. Before coming to Accra they had never seen water coming from a pipe, a flush toilet, a ceiling fan, or slept in a house with electricity. They are quite shy, and I can only imagine they are quite overwhelmed by all of the new people and by all of the new things they are surrounded by. Coming to Accra was a shock for me; I can’t imagine what kind of a shock it is for them. But they have beautiful smiles and incredibly sweet dispositions.

The girls were awake before even I was and the first question they asked was where the brooms were to sweep the compound. They insisted on sweeping and after breakfast insisted on cleaning dishes. They put me to shame, that is for sure! After cleaning, we finally were able to pry them away to take them into town to go to a craft market for the volunteers to do some last minute bartering and shopping before heading home in the evening. They got a proper taste of Accra traffic on the way to the market. Because of the holiday and because of the sunny weather, it seemed as if all of Accra flocked to the ocean, and unfortunately, the road between Teshie and downtown Accra runs right beside the ocean… It took quite a while to make it down the road. Our taxi driver was a lunatic as well. After he backed his cab into another cab and lost his bumper in the process we tossed him a couple of cedis, got out, and walked along the road until the traffic got better and we could pick up a less ridiculous driver.

The craft market was fun, though it is still taking me some time to adjust to the system of bartering here. It’s half a game between you and the shop keeper to see how close to your ideal price you can get, and I’m convinced the other half of the game, when your white, is played by the shop keeper with himself or his friends to see how ridiculous of a price he can get away with asking for his item. It’s a draining process to shop when this is the case, and it’s easy to quickly lose patience and tolerance. Ghanaians, however, even the really pushy ones trying to force a sale on you, are some of the nicest people I have ever known, and though the bartering process is uncomfortable, it is not entirely unpleasant.

The real excitement of the day, however, came when, on the way back from the craft market, we stopped at the La Palm Beach Resort and paid 10 cedis a person in order for the girls to go swimming. They absolutely loved it. The Resort is a five star resort in Accra and is beyond amazing. I was gawking at how nice everything was; I’m ‘sure the girls think we are princesses living in the ultimate luxury here! At the La Palm I got to show the girls the ocean for the very first time in their lives. Mercia spent many minutes just glued to the fence between the hotel and the beach watching the horizon. They also tried their first ice cream (not big fans of chocolate!), chips (the British kind), and chicken sandwiches, all of which they enjoyed.

The biggest, and the best first impression smile I got out of the girls was back at the house after swimming when they saw a train for the first time. Behind our house there is a raised train track (20 feet or so above the house on an earthen mound like a levee), and every day around 6:30 am and 6:30 pm a train runs on the track. From our kitchen window you can watch the train go by. Upon hearing the train we had both girls come to the window and watch. Even after the distinctive train whistle began blowing they had no idea what was about to come. When the train finally did come to pass at dusk Naomi’s jaw just dropped nearly to her chest and her big, bright eyes watched the train’s every move. Once the train had passed (Naomi’s jaw still at her chest), the girls still did not know what it was. Their first guess was that it was an airplane. When we told them about the train they were just so keenly interested. They are superb listeners.

Spending my holiday watching a series of first impressions being made on young girls was far and away the best way imaginable to spend one’s first holiday in Ghana.

Cooking Lessons: Jollof Rice

It has rained virtually non-stop for the past 3 days. Sometimes it's only a drizzle, but then thunderstorms with wind will pop up without warning. As a consequence, the roads are a mess and everyone stays home. We spent the weekend home in Teshie rather than travelling (which we are telling ourselves we will do next weekend no matter what the weather... there are simply some places we must visit). But as a happy consequence, because we weren't travelling and because the ill weather kept us indoors, I had a chance to cook on Saturday.

Sam and I decided we should cook a Ghanaian dish for dinner to be followed by an American dessert. The decision for the main dish was quite easy to make and we quickly settled on Jollof Rice, a traditional west African dish. Deciding on a dessert was much trickier given our limited access to ingredients (no leavening agents and no flour). After much discussion and website perusal, we decided we would try our hand at brownies made with a combination of recipes and substituting pancake mix for flour, though our particular mix lacked any leavening agents. James was kind and offered his assistance and expertise in making the Jollof Rice.

Our "Ghanaian Brownies" turned out to be quite a success, though unlike any brownie we have had before. We did encounter a few technical difficulties in the process of making the brownies, however, including discovering that James has never used his oven and doesn't know how it works. Sam and James had to drive to his brother's house took bake the brownies while I began on the Jollof Rice. In theory, this was a great plan. In practice... the oven heated unevenly and so it took twice as long to cook the brownies as it should have. On the way home, James, his brother John, and Sam were stopped by the police at a road block. The police here are quite corrupt (more on this later), and they were checking all cars with flashlights. As soon as they saw Obruni-Sam in the car, they stopped the car to search it and asked for a cash bribe (quite common here in Ghana). The police had to have been quite disappointed when they learned that all the money Sam had with her was tro-tro change -- less than 1 US dollar! Not all white people are rich...

While all of this drama was occurring, I was well into making the Jollof Rice and was waiting for James to give me the next instructions when the power went out. It's common here for the power to go out for periods of time, but I think I heard a transformer blow. Perhaps it was all of the rain. Fortunately, I had a flashlight to cook with and James, John and Sam were home shortly thereafter, and we all finished cooking together.

Given the chaos of our cooking experience, I am quite happy to report that Sam, James, and John did an excellent job on the brownies, and that the Jollof Rice turned out delicious! I've done my best to record the Jollof Rice recipe if any of you are interested in trying it out! I'll post the brownie recipe too if we re-visit and try and perfect it!

James Dzandza’s Jollof Rice
(Makes enough to serve five & takes about an hour to cook once prepped)

1 small onion, chopped
6 or more cloves garlic, chopped
6 small carrots, peeled and chopped
2 small bell peppers, chopped
Handful of green beans, chopped
6 green onions, chopped
3 small tins tomato paste (1 large in the US)
Spices: ½ tbs rosemary, ground hot pepper, dried shrimp powder (cube), 2 stock cubes)
Rice
Water
Hard boiled eggs cut into quarters

Directions:
1. In a large stew pot, saute onion and garlic in vegetable oil

2. When the onion is translucent, add in other vegetables and cook until tender

3. Add tomato paste, spices and enough water to mix everything together. Turn heat to low and cook 5-10 minutes while stirring frequently.

4. Add as much rice as equals the volume of stew. (ex: 3 cups of stew = 3 cups of rice). You can remove some stew if you’d prefer less rice, but remember that when serving Jollof as dinner, you can always use extra rice! Turn the heat to low and stir until rice is fully mixed with the stew. Cook for 10 minutes, scraping and stirring often.

5. Add water, stir and cover tightly. Cook for a few minutes before stirring. Repeat this process until the rice is fully cooked.

6. Serve the rice with the hard boiled eggs.

So, what am I doing in Ghana?

I've been asked this question quite a number of times and by quite a number of people. Hopefully this posting will help inform.

I am in Accra this summer working for the Women's Health Study of Accra (WHSA). This is a study funded by the United States' National Institutes of Health and consists of 2 waves of household interviews and 1 wave of comprehensive clinical exams. The first wave and the comprehensive clinical exam were completed in 2003 when slightly under 3,000 women from the Accra metropolitan area were interviewed and half of them then taken to Korle Bu teaching hospital where they had blood tests and physical exams. The first wave led to intriguing clinical findings including high rates of hypertension, obesity, and diabetes mellitus -- typically "western" diseases. Though food security, malaria, cholera, and high rates of maternal and infant mortality are still a concern in Accra and throughout Ghana, the "epidemiological transition" (the move from communicable to non communicable diseases as the leading cause of disability and disease burden) is well under-way in Accra. Because Ghana has one of the most stable West African governments and one of the most progressive legislatures, Accra is looked upon by her African neighbors as the way of the future. How health care, health policy, and health in Accra progress is of extreme importance.

This said, given several questions raised by the first wave of the WHSA and a curiosity about the impact of several new policies implemented during the last 5 years, a second wave of the WHSA was conducted in 2008. Wave 2 of the WHSA involved locating the same women interviewed 5 years previously and re-interviewing them with a similar survey instrument to aid in comparability but also to ask about topics not included on the previous survey. These topics

include areas such as national health insurance and health service usage and mental health needs. Though locating the women for interview was quite a task (many of the "addresses" for women read as follows: "Walk towards the yellow house, turn right at the big tree, third hut on left." Despite the difficulty, the office staff managed to re-locate 2/3 of the original women. Those who could not be found were replaced with women of similar age, geographic location and socio-economic status.

The data collection and entry for the second wave of the study is just now finishing. So here's my job:

I am in Accra this summer to begin the basic descriptive statistical analysis of the findings from the 2nd Wave of the WHSA. Additionally, I am conducting a stakeholder analysis and identifying the priorities of organizations and agencies working in Accra responsible for health policy and programming. Once I have discerned the priorities of these influential parties, I am preparing a series of topical briefings from our data with the intent of aiding in evidence based policy and programming in areas concerning women's health and urban health that are of current political and programmatic significance. The goal behind my work is to make our data accessible and available. Publications will certainly result from our data, but it will take years for them to be published, and our data will be made publically available in raw form, but not all agencies have the capacity to process the data. My job is to address this information gap.

After two weeks of work, the task is still overwhelming and challenging. But I am passionate about evidence based policy and programming and am passionate about helping to facilitate the process, particularly as this seems to be the only morally responsible way to conduct public health research.

Though my task is challenging, it is quite fascinating to have the authority and the opportunity to meet with some of the biggest health stakeholders in Accra. In the past week I've had the chance to meet with: the director of the Population Council in Ghana, one of the key drivers behind the current National Health Insurance Scheme Reform, the regional and metropolitan directors of Ghana Health Services, faculty at the University of Ghana, physicians at a public hospital, and many more. In the upcoming weeks I hope to have meetings with representatives from the WHO, USAID, UNICEF, the Ghanaian Ministry of Health, UNDP and more. This is an amazing opportunity to learn about how these organizations function in their country offices and to gain exposure to job opportunities in my field. My hope for this summer is not only that I produce products of use to Ghanaians, but that I gain insights into my own career aspirations.

To complete my work, my daily tasks include lots of phone calls, some statistical analysis, some research, and meetings. At some point I will need to begin writing, but a fair amount more analysis needs to happen before then! The WHSA has an office in Adabraka Official Town and is staffed entirely by Ghanaians. Even though I could do some of my work from my home in Teshie, the office is such a wonderful environment that I look forward to going in. Becky, the office manager, is the sweetest girl you will ever meet. Richard, Maame, Comfort, Silvia, and all of the other staff are incredible people who will make you laugh and try and convince you that you work too much.

One of my biggest challenges in working here in Ghana is relaxing my intense work ethic to come closer to the relaxed Ghanaian pace. Work days here often end quite early (2:30/3:00), and I find myself pressured to leave my work. There have been a few evenings with me working in the office long past when all the other staff have left, and I think I may need to get in the habit of doing this, even if it isn't the Ghanaian way, to ensure that my work gets completed in the short period of time that I am here. Or if not completed, at least to a point where it can be finished in the USA.

I hope this answered some of the questions about what I do and why I am here without being too academic or rambling. If you would like to know more about the study, or my work, I could talk about it all day, so feel free to ask!

For your knowledge:

Population Council, Ghana: http://www.popcouncil.org/africa/ghana.html

UNICEF, Ghana: http://www.unicef.org/infobycountry/ghana.html

UNDP, Ghana: http://www.undp-gha.org/

WHO, Ghana: http://www.who.int/countries/gha/en/

Ghana, Ministry of Health: http://www.moh-ghana.org/moh/default.asp

Ghana Health Services: http://www.ghanahealthservice.org/

I almost forgot... Samantha, the other Harvard student in Accra with me, is working for the same study as I am but doing a different task. Sam's job for the summer is to organize a verbal autopsy project. There were 177 women who were recorded as having died between the first and second waves of the survey though we have no information as to why. Sam's task is answering just that question. There are fieldworkers going out to locate the families of these women (using the only information we have--the last address of the woman, from 2003) and interview them with a verbal autopsy (a questionairre that attempts to discern cause of death). These interviews will then be reviewed by 2 physicians who will attempt to determine from the information provided the cause of death. If they both agree on a cause, this will be compared with hospital records and the death certificates. In Ghana there is no reliable information on the major causes of death, because physicians will record causes of death as "old age" or "exhaustion." Of the 177 women who died, their ages are fairly evenly distributed across all age groups.

Because we're in the same department at Harvard, we are helping each other out on our projects. This means Sam gets to come along on some of my meetings, and I get to go out on some of the interviews from her study. I quite enjoy this collaboration and enjoy having Sam's company!

Accra: Traffic and Transport

Los Angeles, meet your new competition.

2009 marks the year in which for the first time in human history more people in the world will live in urban areas than rural. The metropolis of Accra lays witness to these growing pains. The increase in migrant population from the North and neighboring countries coupled with the middle class desire for more spacious, free standing homes has transformed Accra into a sprawling metropolis with horrendous traffic.

Because I commute into work (in Adabraka Official Town) from the suburb of Greda Estates, Teshie where I am living with a delightful Ghanaian family, understanding the ins and outs of Accra’s traffic is of the greatest importance to me. Though the distance can’t be much more than 15 kilometers, it takes up to two hours to travel between my house and my office at work. I’ve tried to best the traffic by leaving for work and leaving for home early, late, and at a reasonable hour to no avail. The first thing you learn about Accra’s traffic is that there is no rhyme or reason behind it. Perhaps part of the reason there is no rhythm to traffic is because of the system of transportation.

There is minimal public transport in Accra. A state run bus company runs routes connecting Accra with other metropolitan areas in Ghana. Aside from this, the road network is navigated by private car, taxi, and tro-tro. Tro-tros are retrofitted minivans, ambulances, and small coaches likely bought as used vehicles from other countries and re-constructed to hold as many passengers as physically possible. An ambulance sized van will hold 25 people, and a small coach, like the one I rode in today (see picture below), will hold close to 50. Guide books all warn against taking tro-tros because of their safety record, and after just one look at them (especially from the inside), you know your life is in the drivers hands. The thing is, however, there is no alternative to the tro-tro for most Ghanaians.

The ride across town on a tro-tro costs a matter of pesewas (cents) compared to 10 cedis (dollars) in a taxi cab. As further reference, a ride across town in a tro-tro costs the equivalent of a large, filling meal purchased on the street while a taxi ride is the equivalent of dinner at a nice, western restaurant.

In addition to their inexpensive price, tro-tros also have the ability to go off road to avoid traffic. While there is a direct, paved road between my subdivision and my office, congestion on this road is horrendous in mornings and in the evenings. While taxi cabs and private cars must wait in the traffic on the paved road, tro-tros get creative and head off on unpaved, bumpy roads trying to both avoid traffic and pick up more passengers. They are always successful at picking up more passengers, but not always so lucky at avoiding traffic. On these back roads the puddles from the rainy season can be at least a foot deep (I’ve seen a car trying to pass a particularly deep puddle get stuck and flood its engine through as a consequence). Each tro-tro ride is a completely different experience which depends greatly on the skill of the driver, the size of the car, and the amount of rainfall the night before.

My commute to work involves: a shared taxi to the main road, a tro-tro into the city and a second tro-tro to the part of the city in which I work. Not only is there no discernable pattern to traffic, but tro-tros leave when they are full and arrive at their final destination sometime later. When travelling in Ghana you always have to allocate more time than you hope to reach your destination. In addition to the lack of schedule, because so much of Accra is unmapped and streets are unnamed, there are no marked tro-tro routes. You must known the general area into which you are heading in order to tell the driver (tro-tro and taxi alike) where to stop. Eventually you learn the routes you can rely on and the names of the landmarks near where you need the tro-tro or taxi to stop, but when you are first learning the lay of the land, it is an utterly overwhelming experience.

I think there is a market to be made somewhere if an enterprising couple were to operate a slightly more expensive tro-tro with a fixed departure time and a non-stop route into the city. I would pay for that. Gladly.

In the mean time, I view my commute as an exercise in patience and a meditation on relaxing my Western, goal-driven mindset. Sometimes I get so frustrated while hot and sweaty and crammed in an unsafe vehicle with 24 other hot, sweaty bodies watching other traffic cut us off and watching women carrying heavy loads pass us on foot. Sometimes I just want to scream, stop the bus, make all the people in front of me disembark in order that I may continue on foot, arriving at work no quicker, but on my own schedule. Then I take a deep breath, remember that I am in Africa, and

return to my lesson in patience and in Africa time.

(Sam, in the last photo, is practicing her patience on a tro-tro trip home that capped off a 2 hour commute. This was the biggest tro-tro we've been on yet.)

White like me...

Obruni! Obruni!

One of the first words you learn when you arrive in Ghana is ‘obruni’ or ‘white person.’

As a six foot tall, pale skinned blonde, I certainly can’t hide. Wherever I go children call out "Obruni!" Sometimes it’s just a friendly smile, sometimes it’s a shout, sometimes it’s a chant of sorts. There is no way around it, white people just stick out in the sea of beautiful, black skin and vibrant fabrics. Sometimes I forget that I am an obruni and find that, on the rare occasion of passing another white skinned person, I myself am whispering “Obruni! Obruni!”

Obruni is part of my identity in Ghana, just as it is part of my identity in America.

In America I don’t identify myself as a “white person” when asked to respond on questionnaires and surveys. Though I study demography, I disapprove of classification on skin color and find this to be an artifact of times past and an attribute I hope to see discarded in future generations.

That said, I am an obruni. But the difference between being an Obruni and being a white, American young woman is quite extreme. Having grown up in the American South I attended schools and played on sports teams where my skin color wasn’t a representation of the majority. And, to be honest, I often felt uncomfortable and unwelcome. As a white woman from the south, not all staring eyes are friendly at home. There have been a number of occasions where I’ve felt so uncomfortable by my surroundings that I’ve wondered if I’ve not become unconsciously racist in my thoughts and opinions. Being in Ghana, however, has opened my eyes to the fact that nothing could be further from the truth.

I do not feel the slightest bit uncomfortable around the Ghanaians I have met and the Ghanaians I live with. I am the only white woman for miles around, but I don’t feel unwelcome or out of place. What a difference there is between Ghana and the American South! It seems odd (if not flat out wrong) that black Americans and white Americans alike could come to Ghana and feel more comfortable around strangers than they do around their neighbors in the South of the US.

I wonder if others have had this or similar experiences?

Intro to Ghanaian Food

Those who know me in the United States know that I love to cook, and that I am a vegetarian. I have been a vegetarian since my freshman year of college when I abandoned meat and fish for health and environmental conservation reasons. When I travel, as I am now, the issue of being a vegetarian comes up often. It’s a struggle to walk the line between how you choose to define yourself and graciously adapting to the cultural norms and resource limitations of your new home. It can be challenging to explain why one chooses to abstain from meat consumption to fellow Americans, and it is even more of a challenge to do so in other countries. My personal compromise so as to allow me to accept the generosity of my colleagues and housemates who enjoy cooking or buying Ghanaian dishes for me to try and to allow me to experience such a big part of Ghanaian culture—it’s food—is to eat fish, avoid eating other meats, and to abandon worries about whether or not a meal was

prepared with meat. For example, stews made with meat often are made with large portions of animals attached to the bones; I will eat this stew but will decline the offer of including one of the hunks of meat in my serving. That said, in a single week I’ve managed to experience most traditional Ghanaian food. And I’ve enjoyed them all.

Where to buy Food
In Accra, most people purchase their food from street vendors. On nearly every corner, and often in several places in between corners in populated areas, there are little wooden frame boxes in which a particular woman will set up shop during the day selling semi-prepared foods. She will arrive in the late morning with coolers filled with rice or rice and beans and plastic bags or Tupperware (more often plastic bags) filled with the other ingredients needed to assemble a particular dish. Depending on what she is selling she may have a make-shift grill set up next to her stall or a make-shift deep fryer. Both the grill and fryer use as their base a large, metal pan that looks very similar to a wok. Sometimes the stalls will be painted to advertise what dish the woman will sell, but more often than not, you just have to know. Foods prepared and purchased from these stalls never costs more than 1 Ghanaian cedi (current exchange rate: 1 cedi = 1.45 USD) and are sold to you in little black plastic bags, the same kind as in the US elicit novelties are sold in. Soups, stews, rice, dough… everything is wrapped up in a plastic bag, tied, and given to you.

In addition to street vendors there are little restaurants known as Chop Bars that p

epper the city. One particular such spot near to my office makes big cauldrons of soup and stew beside the building and sells them either to people wishing to take them away to eat or to people who would prefer to sit a spell and eat at a table there. A healthy sized serving of stew with a large hunk of dough (more on this to follow) costs only 40 pesewes.

For those who prefer to cook, fresh produce can be purchased from street vendors who sell tomatoes, small red onions, spinach, okra, tiny spicy peppers, “garden eggs” (a kind of eggplant), eggs, pineapples, oranges, plantains, bananas, carrots, cucumbers, and coconuts. Often a particular vendor will only sell some of these foods and sometimes they will sell fish as well. Boxed or canned food items needed for cooking can be purchased from small convenience type stores. It is at these stores you purchase your “pure water” as well.

In Ghana you cannot rely on the tap water to be safe for drinking (if you even have a tap). You can purchase water in bottles, which is quite expensive at nearly 1.5 cedis for 1 liter, or you can purchase a large bag of ½ liter water bags/satchets which have 32 satchets and costs only 1 cedi. Suffice it to say, most people, myself included, drink the latter. Depending on the brand of water the chemical taste varies, but overall I find it to be quite tolerable.

There are some large grocery stores in Accra, but only in the center of the city near

the embassies and the western areas. The majority of these stores are run by the Lebonese and see anything you could ever imagine or want. Betty Crocker cake mixes, specialty sodas from the US (that actually cost less here than in the US), canned goods, frozen goods, Swiss chocolate, paper towels, paper plates, yogurts, icecreams… Shopping in the grocery stores however can be quite expensive and is not how the majority of Ghanaians get their food.

There are proper restaurants in Accra as well. Most are not traditional Ghanaian food and most are located in the western part of the city—Osu. Restaurants charge near American prices for their foods, and, in my limited experience, have the potential for making you feel quite uncomfortable due to the excess of wait staff and the scarcity of diners. One Chinese restaurant I ate in (not my selection) had only 3 tables occupied in an expansive dining room with nearly 15 Ghanaian waitstaff standing around the edges of the room watching you eat.

The last place I can think of at the moment where you might purchase food is from individual

sellers on the street. Women walk around with big baskets or buckets on top of their heads holding everything from plantain chips and yams to pure water satchets. Boys carry bags of apples, loaves of bread, or push carts with Fan Ice, an icecream like product. These women and boys walk through traffic selling their goods to people stuck in taxi cabs, cars, or tro-tros (busses). You could almost do all of your grocery shopping sitting in traffic. You could do more than just your grocery shopping in traffic too—CDs, DVDs , Q-Tips, toilet paper, phone cards, superglue, and the list goes on.

What Food to Buy
I am quite fortunate in that the office I work in is staffed entirely by Ghanaians, so come lunch time, I have expert help at choosing which street vendor to purchase my lunch from and to suggest new things to try. Every day I go out with Becky, the office manager, to buy lunch for all who have requested something. It is my goal that before I leave I have the knowledge, the confidence, and the linguistic ability to purchase my own street food. I think I’ll be able to do this quite soon, actually. My first week of lunches included the following:

Dish 1: Waakye (sounds like watch-ee)
Waakye is a mixture of rice, beans, spaghetti noodles, tomato paste, salad, and gari (dried and ground cassava in granules like cornmeal) and is topped with hot sauces and red palm oil. You can have it topped with an egg, a piece of fish, or a piece of other meat if you choose. I prefer to take mine with an hardboiled egg. It’s not too spicy of a dish (by Ghanaian standards), and is actually quite tasty.
Now when you read all of the guide books, among the things they tell you not to do are: 1) eat street food and, 2) eat salad. On my first day, at my first lunch, I was eating both. All is well so far, but you do wonder if you are tempting the fates. My logic goes something like this: if everyone else in the office chooses to eat the same thing I do and they aren’t ill, it should be okay for me too. Though I may have to go look up the study referred to by this article and re-evaluate my love of waakye: http://www.modernghana.com/news/10266/1/waakye-eaters-prone-to-contamination.html

Dish 2: Banku and Okoro stew (see top picture, bottom bowl)
Banku is a doughy mixture made from fermented maize and cassava and boiled. You use the banku to eat the okoro (okra) stew. The okoro stew is made with tomato paste and okra and in my case had fish in it as well. These were little

fish with many fish bones. I love okra and liked the concept of okoro stew, but the fish were just a little bit too fishy for my liking. You eat this dish with your hands, as you do most Ghanaian dishes.

Dish 3: Fufu and Light Soup Don’t ask me what is in light soup, because I don’t think I want to know. It is spicy and delicious, but I’m pretty sure it has every imaginable kind of meat cooked into the broth. People call it “goat stew” (which makes sense given the number of goats living in this city), but in retrospect, I wouldn’t be surprised if there were some bushmeat in here too. Either way, I was sure to only have the broth put into my plastic baggie. Fufu is similar to banku in that you use it to eat your stew. Fufu is a combination of cassava or plantains and maize but they are pounded together by two people working as a team: one uses a huge wooden pole to smash the plantains and maize and the other uses their hands to fold the mixture over as if kneading dough. Having watched this procedure a few times now, I’m always terrified for the woma

n who folds the dough over in between poundings by the wooden stick as the timing between the couple must be just perfect for her to avoid having her hands smashed.

Dish 4: Kenkey and Pepper Stew (see top picture)
There are 2 types of Kenkey: Accra kenkey and Fanti kenkey. Both types are made of fermented maize in the same process as banku only these balls of fermented maize are wrapped in leaves before being boiled. Accra kenkey is similar to a tamale, wrapped in corn husks. Fanti kenkey, on the other hand, is boiled in what appear to be banana leaves. Again, you use this dough to eat the stew it is served with. This stew was the spiciest of any I’ve had so far, and perhaps my favorite. I love spicy food, and things could even be a bit spicier and I would be happy.

Dish 5: Jollof Rice and Fish
Jollof Rice is a traditionally Muslim dish coming from Senegal and the Gambia and is quite similar to “dirty rice” served with Creole foods in the United States. It is spicy and cooked with tomato paste and onions, salt and spices including chili peppers, nutmeg, and ginger. You can cook it with meat or without meat.

Dish 6: Groundnut Stew and Chicken
I didn’t eat the chicken in this groundnut stew prepared by one of my housemates, but the stew itself is made with peanutbutter, chilis and palmoil. Maybe there was something else in it… but I’m pretty sure it was quite basic. It was tasty and not too spicy, and had a red shimmer from the palm oil. Most, if not all, foods here in Ghana are prepared with a healthy portion of palm oil. There is just no way around it.

An Introduction to Ghana and Me

I arrived in Accra, Ghana on Sunday, June 14th on a direct flight from New York City's JFK Airport with very few expectations and remarkably little luggage (at least compared to my fellow travellers all of whom seemed to have managed to pack small houses into suitcases)! I will be in Accra until July 31st--seven weeks from now--and I've brought with me a little over a week's worth of clothing, some books, and my work things. Needless to say, I hope, and expect, to return home with more than I came with, things both material and non.

Why am I here? I was sent to Accra by a professor at Harvard School of Public Health who runs a health study in the city. My professor, Allan, enlisted my help and offered me a summer internship working for the Women's Health Study of Accra counting towards my degree in Global Health and Population. The study is funded by the NIH and supported by Harvard University and the University of Ghana. In brief, I'm working with major health stakeholders in the city, determining their priorities, and constructing a series of policy briefs on topics of interest to these stakeholders following a basic and first time analysis of the data that has been collected. I will discuss my work in more detail in a future posting. For the time being, suffice it to say I am both passionate about my work and overwhelmed by it.

I haven't written until now because I've had a difficult time just absorbing all of the new sights, sounds, smells, systems, and emotions of my own. The thought of having to distill all of these experiences into a legible, intelligible posting has been simply too much. Now that I've had a week to let the newness of my surroundings, the stress of work, and the jetlag dissipate, I am hoping to squeeze time into my days to post a few thoughts and meaningful tidbits.

If there is anything you'd like to ask about, feel free, and I'll do my best to answer your questions in the form of a blog posting. Thanks for your interest, and Akwaaba!

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Akwaaba = welcome

Obruni = white person