Thursday, November 1, 2012

It's a Ghana-versairy!

First things first, I hope everyone had a safe and happy Halloween, full of ghosties and goblins and candy corn cavities. I actually haven’t been able to celebrate Halloween for the past two years, sort of miss it.

So. I have officially been in Ghana a year now, well, as of October 16, I had been here a year. I'm a bit late on the anniversary post—whoops—but obla di ohbla da…

Anyway, when I first took this job, I had no idea that I would be here this long. My original contract, if you remember, was only for six months. But one thing led to another, and I’ve found myself still here. And since I am here because of the job, I figured the belated anniversary post, should be semi-devoted to what I am actually here for, not just the random musings of a wanderer.

Now I haven’t really written about work much, but we've started a new project here, and while it’s a very small pilot, I am actually quite proud of what we've been able to accomplish in a short amount of time, especially considering the numerous hiccups along the way.

To start from the beginning, my organization was awarded a small $5000 grant back in February from the AIDS Foundation of Chicago, to open a small free STI/HIV clinic for most-at-risk populations in Accra. Full disclosure, I had nothing to do with that proposal; it was submitted before I was even hired. So I can’t take any credit for winning the money, however, because this project is separate from our local partner in Ghana, and I am the only staff member here, I can take credit for all spending of the money…basically I got the fun part :D

But let me tell you, it did NOT start out fun. Just think to yourself for a moment, what would you do if someone just handed you some money, and said go start a clinic? Where would you start? Not to make my story grandiose, but I imagine Noah felt something similar when God asked him to build an Ark (wait, you want me to whaaaaat?) But, sorry Noah, in this day and age, you can google “how to build a boat” and I’m sure you can find step by step instructions. Pretty sure if you google, “how to start a clinic in Ghana,” that’s not going to be the case. Actually, I better go check that before I make that claim…ok, no, it’s not there. Hah.

Anyway, before I could even think about how to start the project, I had to first figure out how to just get the money to Ghana in the first place—which should have been the easiest part of the whole process, right? I only needed to open up an account, because my organization one set up in Ghana, since we work through our local partner.

Now, I’m not going to go all the way into this saga, but in a nutshell, since APRIL, I have gone back and forth to the bank at least ten times, and every time I go, I ask, is this REALLY the last thing you need from me, but then they tell me I need to get some new document from headquarters, which again, shouldn’t be that hard, except they kept making me change the signing mandate on the account and, oh wait, everything needs to be original signed copies from Chicago, and oh wait, now we need documentation from every person who was ever slightly affiliated with your organization to submit a scan of their driver’s license.  And after everything, months and months of collecting documents, they turn around again and tell me that everything I had submitted needs to be notarized and re-submitted.  (Oh by the way, all of this grant money needs to be spent by December. So there was a time crunch as well.)

Never have I ever met a bank so unwilling to take money. Either they’re just the worst bank in existence, or it just goes to show you how much money gets laundered in Ghana.

Long story short, I do NOT have a business account in Ghana. One of my coworkers from HQ, who was flying though Ghana, had to bring me cash for this project. So first challenge, completed.

Next, building the clinic space. For this part I got a bit lucky, because our office is really a three bedroom house, so there is a garage space attached to the side (including a private bathroom) which had previously been used as an internet café, so there were wooden partitions already installed. All it really needed was to extend the partitions a bit closer to the ceiling, to replace the flooring, and to hang privacy curtains around the perimeter. All of which took a surprisingly short amount of time.

After that, I was tasked with finding all of the medical equipment, which was a lot easier than I thought it would be. I only had to go to two different medical suppliers to get everything I needed. Next I had to procure STI drugs, which again, was a lot easier than I expected. I would have thought that you would need some sort of license or accreditation, or SOME sort of proof that I wasn’t going to, I dunno, sell the drugs to kids, to buy in bulk from a wholesale pharmacy, but I was able to just walk in and walk out with $600 worth of drugs.

Actually, the most challenging thing to buy was a bit of a surprise. Not because it was hard to find, but because there are just different names for things here. Believe it or not, it was a trashcan. It’s a pretty funny tangent.

--I go to this little roadside store, because I’m trying to cut down on costs, and I ask the lady if she sells trashcans. She gives me a blank stare for a minute, and says, “I don’t know what that is.” So I try again, “you know, a trashcan, or garbage can.” Again, the woman looks at me, and says, “Garbage can?” I paused for a second, trying to think of what word they might use. A little cartoon light bulb popped above my head as I thought, ok, Ghana was a British colony, what do the British call a trashcan? So I tried again, “I’m looking to buy a rubbish bin.”  

Nope, still giving me a blank stare. At this point I got a bit perplexed. How many names can there be for a trashcan? I wracked my brain, and tried one last time, “I need to buy a wastebasket.” Nope. Strike three. We stared at each other for a minute, and decided that maybe I should try and define the object, rather than name the object itself. So I say, “I need to buy something that I can use to thrown things away after I am done with them.” The woman laughs at me, and says, “so you want to buy a dustbin.” And even though out loud I said yes, in my head I was thinking, “But I ain’t going to be putting dust in it, lady…

It just goes to show you that even if you speak the same language, you might not speak the same language. The whole thing was pretty hilarious.--

But back to the clinic story. Now, at this point, if you’re thinking, who the hell is going to see patients in this clinic—you’d be raising a verrry important point. Yes, I can find a space, and equipment, and drugs, but I’m sure as hell not a medical doctor. Which brings me to another fun little stipulation of this grant: we’re not allowed to pay people. Every penny has to go into direct service delivery. Super. So now I need to find a doctor who is not only willing to work with controversial populations, but they also need to do it for free.

Although, one thing I’ve learned this year about most donors is, for as many rules as a donor can create, an NGO can invent a way around them. So while I can’t, and am not, paying anyone’s salary, I am paying for the clinicians “transportation costs” to and from the clinic once a week. Boom. 

And I could not have gotten luckier with the clinician I found. Through the course of my work on the USAID project, I have made some really valuable connections, both with people and with organizations. In this instance, it’s both.  I’ve had sort of an organization-crush on the West African AIDS Foundation here in Ghana, and even though they are not an official partner of my organization (not yet anyway), I try and work with them any chance I get. First, because they do great work, and have terrific systems in place, but also, because their director and I are like twins who look nothing alike…because she’s a small little half-Ghanaian half-European women. We have a very similar outlook on how programs should be run, and how NGOs should operate, and we just work really well together.

So naturally when I was given this project I consulted with her first. And even though I wasn’t able to steal the director, who is a medical doctor, I was able to steal one of her nurses once a week for my little clinic. And the nurse has been a real asset, both because she is a great person and medical provider, but also because she can refer people to WAAF, which is SO important when we see cases we cannot handle, or someone tests positive for HIV. Our facility is terrific for screening, but we just don’t have the capacity to treat HIV. And when someone is diagnosed, follow up is crucial. But I’m getting off topic.

All that was left after finding the clinician, was to design, print, and distribute referral cards, and then start clinic-ing! To get you all a frame of reference, I was given the money for this project at the end of September, and we were able to open the clinic only two weeks later! Wooo.

Did I explain the whole point of this project? I don’t think I did. Basically, one of the biggest problems in Ghana is that most-at-risk populations are being reached with prevention messages, but they’re not actually going to get tested, both for HIV and STIs. Whether it’s because facilities are not friendly, they can’t afford it, or they’re afraid, the fact is that STIs greatly increase risk of contracting HIV, and STIs are highly prevalent among most-at-risk populations. So, the goal of our project is to get rid of any barrier that might prevent someone from accessing care. Of course it’s not sustainable because we can only operate until December, but if we can just get people to get tested that first time, they’re more likely to get tested again.  

So in real terms, if someone comes into the clinic with the referral card, or they disclose to the clinician during the consultation that they are a most-at-risk population, then they get free consultation with our friendly nurse, free treatment (if necessary) and a small transport reimbursement, at our already friendly office.

The turnout has been truly inspiring. The first day, we were expecting maybe five at most, but I budgeted for ten transport reimbursements, just to be safe. When the clinic opened, I was actually travelling, but I got a call around 2pm telling me that we had already run out of transport reimbursements, and one of the STI drugs. And I was shocked.

And though we have only had three clinic days so far, we have served almost forty people! But don’t think about that in terms of will only gross you out.

Our wonderful nurse doing drug inventory

Anyway, moral of the story, even though I have been in Ghana for a year, I still feel like we’re needed, and making a difference. And who knows, if we can keep up this momentum in numbers of patients, we’re likely to find follow on funding to continue our little clinic.

Here’s hoping.

Oh and P.S. if Mitt Romney wins next week, there’s a chance I’ll cancel my trip home for Christmas. You’ll all just have to come to Ghana! 

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