Favourites

My time in Ghana has finished, so I thought some lists of things was a good way to close.

Favourite Things To Do:
 * Being a fashion designer - you buy the cloth, then you create whatever you want. Could be a disaster, could work out. I had both experiences.
 * Riding my bicycle. I can happily say I had the best bike in Tamale. And it was the best bike I've ever owned. I loved cruising around on it, and it gave me small freedoms that kept me sane.

Mine is the middle bike (obviously the best) and was red for speed

 * Going to Ghana Health Service and viewing their public health tactics - my favourite is using clothes as a public health message. 'Stop TB' or 'Roll Back Malaria' or 'Guinea Worm Eradication Program' is everywhere, what a way to sensitise a nation?!

Jervaise in his Stop TB - use DOTS shirt. I tried hard and hinted much that I wanted one!

 * Read local media articles. It is a different form of reporting, and so sensational you can't help but get caught up into the hype. Here is a personal favourite. Take the time to read it, you'll be rewarded.
 * Greeting everyone. I learnt greetings in quite a few languages, and enjoyed using Fra-Fra with the work guard, Dagbani with locals around the neighbourhood, Twi when in Accra/south, Walle when I was in the Upper West and having a go at anything really, including the many languages of the expats in Tamale. It's extremely rude if you don't greet everyone, so sneaking into your office late in the morning never goes unnoticed.
* 'Creating good relationships' with key people at Ghana Health Service. I thoroughly enjoyed and was welcomed openly by the Upper West Team, I was sad to leave.

Friday afternoon in Wa - the Regional Health team and I discussing my mother's arrival, and possible marriage proposals

  * Buying single serves of everything. Why buy a tin of milk powder when you can have a small sachet?

My local store. Rita looked after my every need, and if she didn't have it in stock she'd get a small boy to get it for me.

* And of course, having fun with friends. I made some (hopefully) lifelong friends, and had such a great time.
 

Favourite Observations:
 * Watching what you can fit onto a motorbike. I saw everything from live goats, up to 5 people, bicycles and many more things. Unfortunately you have to be quick with a camera!
 * Carrying things on heads - observing just what the body is capable of. Up to 5 large bowls of charcoal, raw egg trays, litres and litres of water, ice creams, handbags, you name it. Frees up the hands..
 * Babies everywhere - so well behaved. Strapped onto mother's backs. Easily amused by a piece of paper or a small wave. Taken into the workplace, everywhere is child friendly.
 * No smoking. It is highly frowned upon and just does not happen much. Great for an entire population, I wonder how this can translate to other places. As soon as you cross the borders to the Francophone countries, you get delicious food, but also smokers.
 * Sleeping in meetings. It became a game to see who would fall asleep, how long, and who would notice. It kept me occupied and made the meetings more interesting.
 * Being in a work car with someone who had never been in a car before. He was so shocked by the concept of wearing a seatbelt he almost didn't come for the ride. He thought we were tying him down in the car. Very amusing. He also spoke about how he had never been in a plane. It made me think about first times for everything, it is so much more pronounced in Ghana.

I'll take many memories home with me, all of them good. I will write a few more posts, and maybe about how well I'm fitting back into Newcastle - but if you are in Aus - drop me a line!

Community Spirit

The most impressive thing I have seen over the year in Ghana has been the hard work of the community members for the benefit of their friends, family and peers. The most impressive program I have witnessed is called Community Case Management (CCM). The program is a Ghana Health Service program, with funding from UNICEF. It focuses on the biggest childhood killers in Ghana; 1. Malaria, 2. Diarrhoea and 3. Pneumonia. These are so common in children under 5 that this one intervention, if implemented universally, would reduce the number of under 5 deaths by 63%.

It is a program that is used in many countries, with the difference in Ghana being that the people running the program, assessing the children, going from house to house, being on call 24/7, and administering the treatment are all community volunteers. The community can nominate 2 people, who are then trained and equipped with educational cards, medications and reporting forms.

These volunteers are mostly women, which in the rural areas, means illiterate with no, or very little education. The volunteers diagnose and treat children using the skills taught to them in annual training sessions, a challenge in itself when you are trying to educate without the use of written tools. Role plays are a large part of the training, yet I never quite understand how the volunteers manage to remember the amount of information they do.

Volunteers attending training. Often with their own children. They are in charge of their supplies - in the white boxes, they carry these around on their heads, or if they are lucky, on a bicycle.

The main thing about the program, I have learnt, is that it increases the use of health services by poor children. Due to location, lack of services, lack of roads or transport or other factors, health facility-based services alone do not provide adequate access to treatment (in many countries, not just Ghana), and, not within the crucial window of 24 hours after onset of symptoms. So CCM brings the treatment to you.

It is affordable, treatment is cheap, and if you can’t afford even the recommended amount, it is given for free. Oral rehydration salts for diarrhoea costs a parent about 5c. Of which, 2c goes to the volunteer as ‘motivation’ – the only form of payment these hard working people receive. They are not officially identified as Ghana Health Service employees, and must keep other, sometimes multiple jobs to make ends meet.

The volunteers are given a large workload. Treating, screening and providing follow up care to the whole community. They must report to the closest health clinic once a month with the statistics of who and what they have treated, and re-stock their medication boxes. No transport is provided, these volunteers may have to walk kilometers, with no reward at the end. However how do you fill a report form when you cannot read or write? One health worker I met created a system to help him get reports from the volunteers. In a large jar put a grain of maize for every child 6-11 months treated for malaria. A grain of rice for every child 6-11 months treated for diarrhoea, and a grain of sorghum for every child 6-11 months treated for pneumonia. In a small jar do the same thing for children aged 12months – 5years. Genius.

It is innovations, cooperation and programs like these that makes this country so interesting. Yes, you get many volunteers who do not report, or health workers who demand written forms, but bit by bit Ghana is adapting its programs and building up its people to create something that will one day be a solid health system, built firmly on the strength of its amazing communities. This is dedicated to all the volunteers who give their time to the program, I am so proud of them, and continually hold them in such high esteem. I wish for them to be recognised and given employment entitlements, better status and the thanks that they deserve. 

Meet one of the volunteers - click here.

Memoirs of Ghana

Am I too old to have ‘memoirs’ yet? Or reflect? Probably. Maybe i should say 'anecdotes'. But I have definitely had a great time in Ghana, and learnt plenty of life lessons and professional practicalities. Is this where I get all soppy and tell everyone how much I have grown from this experience, and how I’ve really left a mark here and helped change the world? That would be pretty cool, but let’s be honest, I didn’t.

Reflection is funny, because often you reflect and realise everything you were told was actually true. When I was preparing to leave, the program provided a psychologist to talk through the phases that I’d experience when working and living overseas. An impressive graph was provided to show the emotional turmoil (and fun) that I would experience, and I scoffed at the thought that I would be so predictable…

I wouldn't use the term 'culture shock', but this is the general idea

It’s pretty true really.

It’s all go go go from the start, meeting people, familiarizing, getting lost, understanding the culture/language and seeing through the stars in your eyes.

I thought I’d really been lucky because I lasted a long time without a dip, things were on the up and up and I was enjoying everything (and I really showed that psychologist). But things got monotonous and boredom kicks in, you don’t want to do the same thing every week, every weekend. You withdraw from life and just have ‘Dee time’. But once again, good old reflection kicks in and you realise you only get this one experience, so maximize it! Enjoy it! Friends are also really useful for this. Both back at home (thankyou SOOOO much everyone who stayed in touch, Skyped, sent me music suggestions(yes!!), made the effort, it is the little things, SMS’s, thoughts etc that count!) and friends in country. I’ve met a really diverse group of people; it’s strange being thrown together with so many people- you become friends with people you’d never usually be friends with, in a good way.

And then you realize you are on the home stretch and really need to make the most of things. That’s where I am at now. I’ve been busy busy just doing everything I want to do before I leave. Eating all the food I can get, seeing all the people here I probably won’t spend time with again. Getting fit. Having that final stab at the language (I still can’t really get past ‘hello’, but in my defence I do know how to say it in at least 5 languages!). Trying to figure out what’s been going on in Australia for the past year. and job hunting! Argh! The worst! The thought of going back to real work is quite scary (as I sit here at work typing this out….).

For those of you I contacted in an indecisive freak out (how unusual of me?!?), I didn’t take the South Sudan job. Well actually I did. For a good week I was bound for Bentio in South Sudan for a year as a Nutrition and Food Security Officer working with UNHCR. But after it was bombed and evacuated and I talked to colleagues about the lifestyle there I decided that really wasn’t for me yet.  It was hard because it was the ideal job, being handed to me on a platter. But it felt a bit too isolated and not really the way of life I’m looking for right now. So with sadness I turned it down. Que sera sera.

I still have 6 weeks to go. It’ll fly, and I’ll keep writing (suggestions are welcome), and keep reflecting. I’m no Ghana expert, or nutrition expert now, but I have some pretty good stories to keep me going for a while. I should stop now because 1) I’m not quite finished here yet, and 2) we don’t want this to turn into a novel (albeit an award winning one).

To help myself and you, dear reader to become Ghana experts, here are some do-not-miss Ghana highlights so far;

• ·         Witnessing the full circle of the seasons; the rainy, the dry, the Harmattan, the HOT, the rainy
• ·         Travelling to all parts of the country, it is so diverse each region you travel into
• ·         Learning some of the languages. It gives your tongue good exercise, ensures you embarrass yourself, but also helps to understand the diversity of this small country
• ·         Eating big, eating messy, and eating anything. Granted, I’m a vegetarian, so I couldn’t always eat everything, but it is such a fun experience. To (once again) step out of your comfort zone and go nuts on a big bowl of food you don’t really know anything about can be really amusing
• ·         Enjoying the wildlife. There is not much left, but the wandering goats  and sheep are fun to have around. The elephants at Mole are impressive – I was once driving back from Wa to work and 8 elephants crossed the road in front of me. So free!
• ·         Travelling on the local bus-taxis (called Tro-Tros). Squashed in, no ventilation, many stops, confusion…. But it’s a whole lot of fun, cheap, busy and friendly.

It's a tough life here...... (??)

Joke For Today

Affrika

An attempt at starting a book club in Tamale brought my attention to an article  about writing about Africa. I loved it, and find it so interesting now I’ve been writing myself about Africa, reading about it, and actually experiencing it.

My favourite points;

Africa is a continent, not a country: even the Australian government has made this mistake on their websites. I have heard using the term ‘African’ is sometimes controversial, as Sudanese people are so different to Boers, as to Algerians. “In your text, treat Africa as if it were one country. It is hot and dusty with rolling grasslands and huge herds of animals and tall, thin people who are starving. Or it is hot and steamy with very short people who eat primates. Don’t get bogged down with precise descriptions. Africa is big: fifty-four countries, 900 million people who are too busy starving and dying and warring and emigrating to read your book. The continent is full of deserts, jungles, highlands, savannahs and many other things, but your reader doesn’t care about all that, so keep your descriptions romantic and evocative and unparticular.”

The mention of the African sunset in literature. “Readers will be put off if you don’t mention the light in Africa. And sunsets, the African sunset is a must. It is always big and red. There is always a big sky.” As my roommate pointed out (and not to sound too cynical); the sunsets are beautiful, however I’m not too sure on the difference in appearance here to the sun setting in Australia (or the rest of the world for that matter).

And of course, generalisation; “Broad brushstrokes throughout are good. Avoid having the African characters laugh, or struggle to educate their kids, or just make do in mundane circumstances. Have them illuminate something about Europe or America in Africa. African characters should be colourful, exotic, larger than life—but empty inside, with no dialogue, no conflicts or resolutions in their stories, no depth or quirks to confuse the cause.”

I hope I haven’t made any of these mistakes, and I do take time to be critical of my judgements and thinking. It’s hard not to stereotype a country or continent that you have never been to, and is widely romanticised in literature, press and cinema. Also it is something that is so different to what we know or have experienced. Having said that, I’ve been lucky to lead a relatively ‘normal’ life in Ghana. It may be different to the Ghanaians living in the small communities, but it is the same as my UN colleagues living in Tamale. So I can’t say much for Africa, as my experience is one fifty-fourth of the continent. But I am quick to dispel the stereotypes that are mentioned in the article, and I cringe when I see donor campaigns or advertising that paints Ghana and Africa in the ‘desperate’ light. Although there are some serious human rights abuses and humanitarian crisis happening that you cannot ignore, there are also so many wonderful developments, ‘normal’ living and enriching experiences that are much better to mention.

I highly recommend you read the article, it’s an easy read and from an African person (which is actually quite the change; most things you read about Africa are written by foreigners). While here is a good example and critique on aid campaigns. And here is a fabulous TED talk about the dangers of a single story.

There is a long list I could write about books/articles/movies NOT to read about Africa. I’ve read my fair share of them already and they make me cringe.

There’s your homework for the week – class dismissed!!

Yes, I'm guilty of it. Stereotyping: the token white person with all the 'local' ladies, and malnourished children... did I really do that??

Clearly I got awkward with the situation, and decided it wasn't for me

That's Rubbish!

The rainy season makes everything look so nice. The maize is two times taller than you and as green as can be, so you just think fertility, new growth and all these positive nice things. Then comes the dry season. Everything dies and Tamale is all red dust and plastic bags. I didn’t realise how the trees and bush was hiding such a mess!

The rainy season - the maize hides this... until you turn the corner and are standing on it! The pigs do a good job of halving the size of it daily

When you buy something here it comes in a ‘rubber’ or plastic bag. I heard the black bags are used so people can’t see what you have purchased. Because you may get jealous if you can see someone’s egg and bread – better hide it in a black plastic bag. Fine. But then what happens? You chuck it out the window into either a pile of already discarded rubbish, or start a new pile of rubbish yourself. It’s easy!

And often it’s not just one or two plastic bags you get with a small purchase, but my personal favourite is a pack of lollies you get here – guide to opening them;

1.      The lollie is encased in it’s own individual wrapper for each lollie

2.      About 10 of these are encased in a paper wrapper

3.      This paper wrapper is encased in a plastic wrapper

4.      You will be given a plastic bag to carry this small lollie treat home

So there is rubbish everywhere and of course no recycling. If you are lucky enough to find a bin to dispose of things, you watch the men come and collect the bin, and see it just goes to a larger pile somewhere else and burnt. The educated answer here so far is to just burn all the rubbish. Including the plastic. Makes for a lovely aroma, especially on dinner time. The rubbish near my house creates a large pile for the animals to fossick through and get the best parts, but there is no end in sight for the plastic bags. It is interesting how revolutionary the plastic bag has been for people here (making things so accessible and easy to sell/buy) however, the bigger, longer problem of waste collection is a long way coming. I take a stand and collect my bags, and give the re-useable ones to the ladies who run the shop down the street. But Ghana is choked by rubbish and no means to deal with it.

Sheep spotting - is it an animal or rubbish?

A pretty standard/clean sight. The view from my guest house. oh, the guest house didn't have a washroom, so this was also the toilet...

Ghana Quirks I Enjoy

Some are funny, some are just interesting to me….

1. Using old diaries as a note pad, I’ve seen as far back as the 1990’s. It’s really common, and I just am not sure why… recycling?
2. Painting the nails on the left hand only, not the right
3. Taking multiple solo photos of yourself or friend in front of anything, no smiles allowed, very serious business (in the south, this is done often with an iPad in your face, always an amusing sight)
4. Either not wearing makeup at all, or makeup applied drag queen style
5. Playing ‘background’ music as loud as the volume possibly goes. Makes small talk easier, you sit in silence!
6. Washing your hands before eating with dishwashing liquid and water. Why not soap?
7. Dinner parties mean come, eat really really fast, and then leave… without paying the bill (and with taking a take-home pack). A friend negotiates this at work functions by doing presentations and everything before the food is served. I can never keep up with my colleagues – maybe because I chew things like fufu, the Ghanaians don’t chew, just put-in-mouth-and-swallow
8. Not waiting for the current conversation to finish before butting in with a new conversation
9. Hanging your handbag over your bottom – sort of bumbag style. Literally flaunting your curves. People here love to keep their hands free – handbag often goes on the head too.
10. Using the word ‘sh!t’ in a formal meeting to describe, well, sh!tting in public. I was with a national minister, and I was shocked we were talking about trying to stop people sh!tting in the open… I find ‘defecation’ (often used as well) so formal… but then sh!t is the complete opposite! My guard also talks about how our chickens ‘sh!t’ the eggs… I tend to get the giggles...

     To leave you now with a song that is often guilty of point #5. I tried to buy some things from a shop the other day, but the lady serving had to dance to the entire song first before we could exchange any money, it was worth it. It's my favourite song here, maybe because I think it is so funny. It's a guarantee you'll hear this if you leave the house in the morning. 

Joking Around

They say you understand the language or culture when you can tell a joke in the language. So far I am simply trying to figure out when to laugh so I look like I understand. Ghanaians have a great sense of humour and love a good laugh. There is plenty of back slapping, high fiving, finger clicking and reminiscing of punch lines going on.

Ironic humour doesn’t work. And for me, telling a funny story can result in the response of “Oh, I’m sorry-yo” when I’m waiting for a laugh. From what I gather there is a lot of tribal humour, one driver loves to tell everyone that isn’t from his clan that they are his slaves. This always brings in the laughs, just when i feel he has really insulted someone by asking them to ‘run away’ (in my mind this means ‘get lost??’) or ‘get rid of your father’s slave name’. I realise I can’t quite pull these jokes off, so I try to focus on other topics.

My new chief met with the Regional Health Director with me recently. She gave him stern words about not having been to his office yet, and how he is more committed to work than receive her in the office. Hilarity ensued with me laughing nervously by her side...how is that funny??

So my main focus now is to just follow the conversation. Winding emotional stories are used to communicate here. My humour comes mostly from watching my colleagues and friends crack themselves up and my total ignorance to the joke.

But I’ll leave you with one that made people laugh for days, I get it, but I laughed for a second or so and left it. But the joke was bought up all week, and I’m sure if I saw someone who was there now, they’d still be laughing;

JOKE:

The difference between directors and leaders; the directors write cheques, and the leaders make decisions….

?

The Case of the Mosque and The Missing People

Not to let work get in the way of a good adventure, the team stopped outside of Wa for a look at one of the ancient mosques of Ghana. It’s made from mud and sticks, and is reminiscent of the Mali ones, yet maybe on a smaller scale (I haven’t seen the ones in Mali). It was great. 

The mosque, looking into the women's entrance

Inside, it was very small, but it would fit many people at prayer time

We got to enter (me through the female access of course) and even go to the roof through a tiny opening. The local kids caught onto the sight of cameras and went nuts. Can’t keep them away from the lense.

Next door to the mosque

View of the local town from the roof

Exiting the roof through a small hole. and windy mud stairs backwards. quite the skill.

A 16th century mosque, I didn't actually learn all that much about it but just enjoyed being a tourist. I looked it up to maybe shed some light or interesting facts on the mosque, but the best I could find is that it is "a very solemn place". Ghana has to work on it's online tourist presence a little bit... or I should listen more. But at least I didn't go AWOL...

No shoes were harmed during filming

After maybe half an hour investigating the place, we set off in the convoy again. However our car was missing the two journalists that had come along for the day…. So the security vehicle called the convoy to a halt and we searched the town for the journos. I’m talking a tiny village with a handful of houses. I couldn’t get my head around the fact we’d lost two people in this small town. And they weren’t from here too, so I’m sure they’d be noticed. After an hour of waiting, we found that they had caught a bus back into town. Who knows why. There was mention that they probably had a more lucrative story waiting for them in town. That is how the media works here, you pay for the journalists. Crazy. So this was an interesting insight into the media world!

The team was not happy, outraged at having lost an hour of time... even though we'd just spent the morning sightseeing. But we soon set off for more work site inspections, (sans journalists).

Camera spotted! posing starts. The children love tourists.

Children and their toys.... and giant smiles

security escort courtesy of the local kids

Waiting for the journalists to appear... the town locals quite enjoyed the drama

Neighbourhood Watch

Defining a Household:

“People who slept here last night and ate from the same cooking pot”

Does this mean that the Jenkins’ who often have three cooking pots (1 “normal”, 1 vegetarian, and 1 gluten free) is not one household? Three households under the same roof?

Defining a household is important in the nutrition surveillance system I am helping implement in the three Northern Regions of Ghana. It always brings such controversy because the living situations are so diverse here. It is not uncommon for many households to be living under the same roof (house). Hence the addition of the statement ‘eating from the same pot’. This will generally distinguish the different households, as commonly, food for only the immediate ‘family’ can only be afforded.

The average household size in the Northern Region is 6, yet the number of people living in a house can vary greatly. In one community I went to, the chief’s house contained hundreds of people, however many “households”. So it is an interesting question, and reflection of the living situation in Northern Ghana. I have been fortunate enough to go to the communities and help train the health staff on how to take height, weight, MUAC (mid upper arm circumference) measurements for malnutrition screening, as well as mortality and household data. It gives you an insight into the living conditions and cultural traditions as well.

The Dagomba tribe (Tamale area) generally give away their first girl child to a sister or brother, to help in the house. Once they are in their 20’s or so, they can go back to their family, but it seems there is always a disconnect between them.

The Upper West has the greatest gender inequality. Women may have some of their own land, however must farm the man’s land first, therefore never quite meeting the needs of their own land. I don’t think they ever can receive land through the death of their husband either, they must go to be a second (or third) wife in the husband’s brother’s household, or must marry again (which is hard when you are older).

Also the ‘community entry’ routine is interesting. You must greet the chief which means entering his home without your shoes, making sure you are lower than them, say hello (in the local language to really ‘integrate’) and clap your hands slowly. Then you ask permission, discuss, thank, and ‘dash’ or ‘give kola’ which used to mean a present or offering of kola nuts, but now it means give some cedi (money). Exiting the community is equally important and a visit to the chief must be made.

So back to the definition. According to Ghana’s standards, the Jenkins family home (when Kat and I still lived there) had three separate households living under the same roof. It's all relative, and a great lesson to learn living abroad. Never generalise but learn from your situation.... enjoy.

MUAC measurements being taken

Weighing child - with mother 'tared'

Taking household data. Under the tree in the village.

Height measurements mostly make the children cry... This one was lucky!

Community exit. Thanking the chief. and photo op!

All crammed into a 'tro tro' - a local minibus. was the way to travel!