Eight Months Later

Well, I clearly failed at keeping this updated. 

Eight months, and many, many plane rides later, I have started a new position with the same organization (Heartland Alliance International, for anyone who forgot). Our project in Ghana came to a close in August, as our contract with USAID expired. And unfortunately, because of US “competitive bid” processes, we have to re-apply for funding. Which really only makes partial sense to me. Sure, you don’t want to play favorites and keep awarding funding to the same organization. But if you have a fully established project that is achieving your strategic objectives, why would you stop funding it, causing gaps in funding, loss of staff, loss of property, loss of momentum, duplicative startup costs and other undesirable things? Some overpaid economist should do an analysis on how much money is lost between grant cycles… 

Anyway, I am now a Field Program Advisor, which in theory is a cool transition, but we’ll see how it pans out. I’m taking this attitude not because I’m not excited to bounce around to various programs, but because the funding for my position is conditional on funding from the program offices. So it could be a very short lived experiment :)

But here I am, at my first of hopefully many short-term assignments in Abidjan, Cote D’Ivoire! Just a hop, skip, and a jump away from lovely little Ghana.

Boing.

 

However, upon arrival, I immediately noticed one significant improvement from Accra…NO MORE OPEN SEWERS! (and the crowd goes wild…yaaaay). Yes, thank you Abidjan for having the good sense not to expose all sorts of filth to everyone’s nostrils. However, it is impossible to walk around this city. No sidewalks, crazy traffic, really, really sprawl-y. So, there you go Accra, point you. Its 1-1. Unfortunately both cities are tied in the “horrible traffic” category, so I’ll have to get back to you to see who’s gonna win this horse race.

As for the actual job, I’m really excited to be here. Heartland has its own office, which if you remember we did NOT have in Ghana. And I had met two of the Cote D’Ivoire staff before, one in Chicago and one in Tanzania, so I already knew I was coming into a great team. The project here is very similar to the one we were working on in Ghana, but on a much, much larger scale. We had one local partner in Ghana...there are 15 in CI! And that number is going to increase to 20 in the next month. The other main difference is that while we only had the mandate to do HIV prevention in Ghana, in CI we do HIV prevention, testing, care, and treatment. It’s a busy office. 

Anyway, my role here is pretty varied. And it’s all in French. Ah! The country director and my HQ supervisor have created quite the workplan for me. If you can stand to sift through some NGO mumbo-jumbo, my tasks include a comparative analysis of the three different implementation models for partner organizations, documentation of success stories for external communications, program development, review of the M&E system based on recommendations from a CDC consultant, local partner capacity building and tool development, ensure correct targeting of populations...blah blah blah, I can feel your eyes loosing focus, so I’ll skip the rest. 

But I do have a rather strange story from my first weekend here. I met this Ivoirian woman at a café, who has hence decided to adopt me (which strangely happens to me a lot. I’ve been told more than once that I have an “approachable face.” Maybe I should work on that...) Anyway, we got to talking and she told me about her travels and her work (she owns a farm, fyi), and she told me that her sister owns a restaurant in Abidjan, and her brother-in-law would drive us there.

Sidebar: we had a really awkward moment because the word for brother-in-law in French is beau-frere, which can sound a lot like boyfriend. So at different points in the conversation, she referred to this man as what I though was “boyfriend” as well as husband of my sister. Needless to say I was confused. But I figured it out eventually. 

So I met her brother-in-law, who SHE told me is from Jewish, and would not change her mind no matter how many times I told her Jewish is not a country, but as it turns out he is from France. And yes, he is Jewish. 

We all got in his car, made a stop at my new friend’s mother’s house, to be introduced to who is apparently now my grandmother, and then we went to her sister’s restaurant. The restaurant itself is pretty cool. It has a nice beachy feel to it, despite having no view of the ocean. It also houses several interesting animals as “pets,” which brings me to the weird part about this story. I arrived just in time for a monkey surgery. Whether or not this was a scheduled endeavor and my new friend failed to inform me, I don’t know. But it happened nonetheless. 

Let me explain. Apparently this restaurant plays host to two monkeys, I’m not sure what species. Maybe my environmentally inclined sister can tell me from the pictures. One monkey is still kind of a baby, and his name sounds like Peking, which I find very funny, so I will continue to call him that. But sadly, Peking was attacked by the larger monkey, leaving his poor little hand pretty ripped apart.  

The family who owns the bar did not have (or would not use) the money on the monkey, but one of their frequent patrons, another French guy, is a handy carpenter and apparently now an amateur surgeon. He went to the drug store and bought an assortment of drugs and bandages and a NEEDLE to fix poor little Peking’s hand. 

So when I got to the bar, they were in the process of organizing said-surgery. And my new friend volunteered to hold the monkey down! They gave the monkey some anesthesia (yes, you CAN get that over the counter. Doesn’t that frighten you?), and then the carpenter proceeded to sew Peking’s skin back onto his hand. Not something I was planning on seeing that day, or really any day in my life. 

Surgery slide show:

 

You can kind of see his wound on this right hand

Monkey surgery commences!

  

Got a nice little boxing glove.

Monkey treat for being a good boy!

Oh yea, and to finish off the monkey story, they brought back the big monkey that had hurt poor little Peking. AND they gave her a lollipop. How is that for justice?

 

I also made friends with a mongoose, named Pilou. He licked my ankle. We’re bff. 

TELL ME THAT’S NOT THE CUTEST RODENT YOU’VE EVER SEEN!

Also I'm clearly not in Ghana anymore, but I cannot change the web address of this blog. That would be silly. So I guess I'll start new posts (if there ever are...) with the location. Sound good?

Going on Tour

For all of you that I was not able to see during my all-too-brief visit to the US, I hope you had a merry Christmas, or happy Chanukah, or an awesome Festivus for the Restivus! (Does anyone actually know people who celebrate Kwanzaa? Cuz I don’t.) And of course, a Happy New Year!

I’ve been back in Ghana for about a month now, and have fallen steadily back into the pattern of daily life. Some quick little updates before I dive into the juicy stuff—we have two new volunteers now: one a student from Canada, the other a nurse from Boston, and I have to say, it is not only nice to have other expats around, but it’s even nicer to have other females around for a change. Not that I don’t love my co-workers, but it will be nice to have voices to back me up when the whole, “women belong making babies or dinner” argument inevitably surfaces again.

Another short update: the grants funding both projects I’m working on in Ghana are scheduled to finish up this summer, so something’s going change in the next few months. Stand by.

So. I thought we’d kick off the New Year (yes, I know its February, but this is the premier post of 2013) with a little work talk, and wrap it up with a little fun talk. Not that work isn’t fun, but, you know, all work and no play make readers fall asleep...or something like that.

Part One

To begin:  The USAID grant I work under is a three year project, and each year of this project, we are supposed to expand programming into new regions/cities/villages/whatever. So in the first year we were only working in Accra, in the second year we expanded into two major cities in the Volta region, and now, in year three, we expanded into five new villages in the Volta region. It’s really quite exciting because these villages have not really had our type of program before.

In a community driven project, you need to get the community involved (obviously). And one challenge that we have faced in other places, is really getting our name out there, other than within our small target population. To address this problem, one of my coworkers and I had an idea to combine interactive theatre performances, to lure in the crowd, with free HIV testing and health screenings, to really show the community what we (sort of) do. Through some interesting brainstorming sessions, we finally came up with a “going on tour” concept, complete with tour bus, health equipment, t-shirts, roadies and groupies. Ok, maybe not groupies.

But in order to start working in a new place, there are certain protocols that need to be followed. (Especially in Ghana, where they looooooove their bureaucracy and rigmarole protocols). So late last year, our project coordinator in the Volta region and I went around, meeting with the local assemblies and clinics in each village, to get them onboard and involved in our project. It was a long process, and a nightmarish cornucopia of logistics, but two weeks ago we pulled off the grand village tour of 2013!

Some of our actors on the tour bus

It was quite an adventure—six theatre performers, three office workers, our volunteer nurse, and me. We hit five villages in five days, which may not sound that impressive, but if you could only see the roads that connect these villages, you would understand.

So here’s an outline of our event:

In each of the villages, we set up a table and small screen for HIV testing in busy parts of town—markets, stations, squares…etc, the idea being that we wanted to be in the place that would get us the most attention (youngest child syndrome for NGOs..) After setting up, the theatre performers start one of the numerous silly games that they play, usually in a circle involving some sort of song or dance, to attract attention. After enough people have gathered, the theatre facilitator explains that they are about to put on a small performance, and then introduces the main character. Then the performance begins!

The storyline we chose for these events was a story showing HIV stigma and discrimination. It follows a young girl, who completes Junior high school, and wants to continue on to Senior high school, but her father is unable to pay her school fees. After visiting a few relatives who are also unable to pay, the young girl goes to one of her school mates, to see if she can help. The school mate tells her about a man who has been helping a lot of young girls pay their school fees, and offers to call the man and introduce them.

Protagonist in the center

When the main character goes to visit this man, he makes it appear like he is not going to help her with schools fees, unless she “helps” him as well. (What’s our poor protagonist to do?!) In the end, she succumbs, and soon after discovers that she contracted HIV.

Being seduced!

After learning her HIV status, the main character confides in her father, who throws her out of the house. Left with nowhere to go, she returns to her schoolmate that introduced her to the man, but after the schoolmate learns that the protagonist is HIV positive, she rejects her as well.

Angry Daddy!

Begging :(

The performance ends with the protagonist on her knees, begging the audience to help her. It’s a sad story, and unfortunately, the dilemma the protagonist faces is not uncommon in Ghana. Transactional sex is pretty normal, and many families struggle to pay school fees for their children.

Anyway, following the performance, the facilitator comes back out to lead a discussion on HIV stigma, modes of transmission, and the importance of learning your status—a perfect segue into the next phase of our event—HIV testing and BP screening!

Volunteer nurse checking BP

Each event was set up a little differently, but for the most part, we had a nurse from the village clinic conducting the HIV tests, and our volunteer nurse screening for high blood pressure. But in some places, people were only interested in HIV tests, so both nurses were doing HIV testing. Anyway, while people were waiting for their turn, we had condom demonstrations, STI talks, and passed out lots and lots of reading materials. 

Condom demonstration

'

STI Discussion using real pictures of STIs...I'd post some, but they would give you nightmares

And although there were some hiccups along the way, which is to be expected since this was our first time doing something like this; all in all, the events were very successful. We even had to turn people away at times because we didn’t have enough HIV test kits to meet demand! It was pretty encouraging. Hopefully we can do a follow up tour soon. And maybe this time, we WILL have groupies.

The crew! 

Part Two

The Volta region of Ghana is one of the most beautiful (in my opinion). It has Lake Volta, the Volta River, mountains, MONKEYS, and a whole bunch of other natural attractions. But even though I have been in Ghana for a significant amount of time, I have not seen it all! While time is a big challenge, the biggest challenge is finding someone to go with. Most Ghanaians have either been before, have no interest, or have some other reason for not being able to go. This is why I am happy to have new volunteers! Because they haven’t been places, they want to go, and they usually only have a few months to try and get everywhere they want to.

So, after our week long village tour in the Volta region, the volunteer nurse and I stayed the weekend, and did some sightseeing—first to Wli Falls, and then back to the monkey sanctuary!

This sign make me giggle..bats and butterflies are the only creatures worth specifying! 

Wli Falls, the highest waterfall in Ghana, gets its water from the Agumatsa River. To get there is a fun hike, which you can either take one hour to the lower falls, or three hours to the upper falls. Unfortunately we got there too late to do the hike to the upper falls, but it was still a really nice walk and you have to cross a bunch of log bridges that take you over the zig-zag river before getting to the falls themselves.

I think the pictures pretty much speak for themselves.

The path to the falls

Giant tree

One of many log bridges

The falls!

 And, even though I was not planning on it, we did end up swimming under the falls. But my friend had to wait a bit before we could go, not because I was scared, but because when we first got to the falls there was a big group of students there, and I was not willing to be the subject of camera phone pictures and videos, wading across the rocks in my underwear! And despite many stereotypes of Africa, it was freeeeeeeeeezing!

You can see us way in the distance. Our guide was not the best photographer, haha

And although I did go to the monkey sanctuary again, my camera was dead at that point, so I wil have to get the pictures from my friend before posting about that leg of the adventure :)

The Infamous Sign

This sign is posted near one of my favorite bars. It cracks me up every time I see it, so I thought I should finally take a picture, and share it with the blogosphere...

I do feel bad for anyone who takes this seriously, and tries to solve some of these problems through this woman. I should call the number and ask her what her success rate is...

Microwave Thanksgiving

Thanksgiving in foreign countries is always an interesting experience, and I'm never quite sure what to do. In Niger, each of us planned beforehand to bring something to make as a potluck--but in Ghana, I'm not here with colleagues to plan ahead with. Of course you have those expat gatherings, usually organized by the Embassy, where you can find all the right food and blah blah blah. But I think that's boring.

I've learned so much about Ghanaian culture, traditions, and holidays, that I wanted to try and bring an America tradition to my friends here. But, much easier said than done for a few key reasons: 1) I don't have an oven..or a kitchen, for that matter. I have a microwave. 2) Cooked Turkey is IMPOSSIBLE to find. 3) Power outages are unpredictable and spiteful.

So, bearing those three key factors in mind, I set out to create a make shift Thanksgiving imitation, to try and show my friends what this American holiday is like. First step was finding the food.

My initial idea was to try and find the sides and main dish already cooked, since I knew my ability to actually prepare food was limited. But after searching high and low for cooked turkey, I decided that oven roasted chicken would have to suffice. The mashed potatoes also proved tricky. I even went to the KFC to try and find pre-made mashed potatoes -but they didn't even have them on the menu! How can you have a KFC with no mashed potatoes, I ask you?! Anyway, after considering several options, such as mashing up french fries, or boiling potatoes in my electric water heater, I decided that the easiest option would be to buy frozen mashed potatoes and cook them in the microwave. However, I couldn't even find plain mashed potatoes! The store had frozen mashed potatoes blended with sprouts, or frozen mashed potatoes blended with spinach. Both bizarre--but I decided that the spinach combo would be less weird.

But at that same grocery store, I also found instant stuffing, instant gravy, and frozen peas and carrots, making my meal mostly complete, and thus, microwave Thanksgiving was born!

I called up a few friends, commissioned one of them to bring some wine, bought all of my ingredients, and set out to create my feast. However, just as I walked through the door of my apartment, the lights dramatically went off! Not only did this ruin  my Thanksgiving plans, but, as anyone who was at my parents' house knows, it made the traditional Thanksgiving day skype call a bit of a challenge as well. Fortunately I have a simcard powered modem, so I could access internet, but visibility was a bit of an issue on my end, even after lighting several candles. But it was still fun to chat, and get to be "part" of the holiday with family.

But back to microwave Thanksgiving! The good thing about having all frozen/instant food, is that it is inherently made to last. Which means that while microwave Thanksgiving had to be postponed, none of the food was ruined.

So last night, I gathered some friends, made my microwave earn its keep, and American Thanksgiving was celebrated! The chicken was great (obviously because I didn't make it), and the rest of the food was saved by salt, butter, and the gravy. Gravy makes the meal, in my opinion :)

And while I assured my friends that real Thanksgiving food tastes much better than what they were eating, we had a lot of fun, anyway.

We got pretty silly towards the end.

I hope everyone had a safe, and delicious Thanksgiving!!

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 STIs...it 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!