Last Saturday night around midnight, I was standing in the middle of a street in Tamale, trying in vain to beg or bribe a taxi driver to stop and take a dying man to the hospital. I hadn’t seen the motorcycle collision that injured this man and one other, but the small crowd, the battered bikes, and the bloody, limp bodies told the story clearly. My makeup, blond hair (combed for once), and red dress, which correctly marked me as a foreigner on my way to a dance club—normally very desirable fare for a taxi—suddenly carried little cachet. As multiple taxis turned me down, two of the man’s friends began a futile and possibly fatal attempt to load him onto the back of the motorcycle. His neck and limbs flopped sickeningly as the motorcycle sparked to life and died repeatedly.

In the end, the only way we could convince a driver to take the man to the hospital was to have a white person accompany him. A friend of mine drove ahead of the taxi on his own motorcycle, carrying one of the man’s friends. We paid the driver four times the going rate. As they drove away, a woman watching the scene remarked to me, “Of course the taxi driver can’t take the man. When he gets to the hospital, they will hold him responsible and make him pay if the man can’t.”

Welcome to a world where individuals have the liberty not to have health coverage, and face the consequences for how they exercise that liberty. In Ghana, you don’t get treatment—sometimes even life-saving treatment—until you prove you can pay for it. Doctors will sit and watch you bleed while your friends and family cobble together money for payment, or rush to renew your health insurance policy. I once saw a four-year-old boy delivered to a rural health clinic after he ran onto the highway and was hit by a motorcycle. There was nothing the clinic could have done to save him. His mother spent his last moments not by his side, but running desperately through the village to get his insurance card.

The issue of allowing indigent or liquidity-constrained individuals (those who could pay back their medical bills over time) to die aside, the serious economic issue here is that when the default assumption is that people cannot pay for health care, there are negative externalities that mean even those who can pay for care may not get it promptly, and as a result, may have worse outcomes.  A man with thousands of cedis in his account should be able to get a taxi to the hospital; he should not be left on the road because the drivers fear he will be turned away on the hospital steps. A child with insurance should be treated promptly; he should not be left bleeding on a clinic table while his mother runs for proof of insurance.

Those who support universal health care, or an insurance mandate, should not fail to recognize the costs, in terms of our government budget deficit, burden on the poor, and loss of economic freedom.  However, those who are opposed to it should recognize the full costs of that liberty as well.

I often fantasize about plots to confound muggers and highway robbers. (I know, this probably suggests I need to go on more dates.) One of my favorite—and less disturbing—plots involves buying a knock off designer purse, filling it with rocks, and prancing around with it at Gumani intersection after dark.  I take particular pleasure in picturing how the inevitable purse snatcher will stagger under the bag’s surprising weight, and the look of dismay on his face when he opens his hard-won prize.

This paper by Cormac Hurley of Microsoft suggests this might not be such a bad idea.  The paper models the economic decision made by an attacker, taking into account the cost of initiating an attack, the payout if successful, the total number of viable targets, and the density of viable targets among the general population.  The model shows that to make attacks economical, ability to identify a subpopulation with a high density of viable targets is key.  

The paper’s findings have important implications for how we might approach crime reduction strategies in Tamale.  Generally, one can try to deter crime by increasing the cost of engaging in it, or by reducing the benefits. 

Increasing cost: You can do this in a few ways. First, you can increase the penalty if the attacker is caught.  You can also increase the likelihood that the attacker is caught.  Either way, you increase the “expected”, or average, penalty for engaging in crime.  (The rarity of catching criminals in Tamale is the main reason I am sympathetic the high penalties imposed in vigilante justice here.) You could also do this by increasing the cost of attempting an attack regardless of penalty, say by forcing attackers to sustain injury in order to get a payout.

Reducing benefits: You can reduce the benefits of attacks by reducing the frequency with which criminals get a payout (reducing the number of viable victims), or by reducing the amount of the payout if the attack is successful.

While this may all seem obvious, the Hurley paper’s model sheds some light on the efficiency of different approaches. The model suggests that reducing the frequency with which attackers get a payout can have a much larger effect than increasing the cost of crime or reducing the amount of the payout.  For instance, in one example in the paper, if an attacker can successfully identify viable victims 99% of the time, and the ratio of the payout to cost is 100, the attacker will end up attacking 32% of viable victims. If you reduce the payout to cost ratio to 20 (you could do this by reducing the payout by 80% or by increasing costs by 400%), then the attacker will attack about 15% of viable victims. However, if you reduce the attacker’s ability to accurately identify victims from 99% to 95%, the attacker will only attack 4% of viable victims.

The challenge with crime in Tamale is that the cost of committing it is pretty low, due to lackadaisical policing, and the ease with which attackers can identify viable victims: white people out late are almost always a viable target.  Increasing police vigilance will be difficult to effect, especially without risk of repercussions such as curfews and travel warnings that might lead organizations to avoid Tamale. The good news is that a strategy we can more easily implement—decreasing the percent of Tamale expats who are out late and are actually viable victims—is likely to be a much for effective strategy anyway.

So what can you do? Make sure you are not a viable victim. Don’t carry anything that could be a payout for an attacker.  Don’t do things that make you an easy target, like get drunk or carry bags that are easy to take away.  Travel in groups, and in areas where help will come quickly.

You have probably realized that a corollary to this is that increasing the total number of people who are out late, and are not viable victims, could be a very effective strategy to deterring crime.  However, in the case of Tamale muggings, being a non-viable victim still carries risks, and I am not advocating that anyone go out at night with the goal of being a “false positive” in an attempt to reduce general crime.  But if you see me at Gumani junction with a fancy bag that looks awfully full, you’ll know what’s up.  

As I was leaving the office the other day, I realized that I’d been planning to make a trip to the bathroom for the past 3 hours, and hadn’t yet done it.  This sometimes happens when I get busy.  Growing up taking 4-hour bus trips to get to athletic events will do wonders for your ability to hold it.

However, the day hadn’t been that busy, so as I made my way to the office bathroom, I wondered why I’d put off my bathroom break so long.  After finishing my business, I noticed there was no toilet paper.  Well never mind, par for the course in Ghana.  That taken care of, I went to unlock the door and vacate the bathroom. I turned the key in the lock—but the bolt remained firmly in place. I frowned, then rotated the key another 360 degrees. Same result.  I sighed. Why do I put off peeing? Oh yeah. This is why.

If you are male, your urination options are almost infinite in Ghana. No need to worry about exposing yourself near schools and playgrounds; all the kids are peeing and waving at you anyway! Peeing and waving! It’s the best ever.

If you are female, you are theoretically free to join in the peeing and waving. In reality, if you are female and white and you do this, the kids will likely stop peeing and waving and start staring.

If you choose to forego the peeing and waving approach, bathroom options become much more limited.  Bushes would seem like a natural option in rural areas (although my more cosmopolitan friends inform me that the majority of Americans have not actually peed in the bush before), but even rural areas are pretty populated in Ghana, so unless you are really out in the boonies, peeing in the bush can readily turn into peeing and waving. 

Non-bush bathrooms in Ghana range from swanky to biologically hazardous and probably combustible.  When confronted with a Ghanaian bathroom, you will face a choice: pee or hold it. To assist you in your decision, here is my handy pee procrastination tool:

1.       How many 250 ml servings of water have you had since you last peed? Add one point for each serving.

2.       How many hours will it be to the next convenient bathroom option? Add two points for each hour.

3.       Add one point for each of the following that the bathroom has: toilet seat, toilet paper, running water, soap, enough light to see without your cell phone light

4.       Can you see feces? If yes, subtract 2 points.

5.       How many flies are there? Subtract 1 point for every 10 flies you see.

6.       How many canaries would the smell kill? Subtract 2 points per canary.

7.       Subtract 1 point for every cockroach, toad, rodent or bathroom attendant who hits on you. Subtract 10 points for every mamba. 

8.       Is the bathroom unisex? Refer to #firstworldproblems.

If you score 10 or higher, congratulations! Go ahead and pee! If you score below 10, procrastinate.  

You are now likely wondering how long I spent in the bathroom coming up with this metric.  Well, after the door failed to unlock, I contemplated alternate escape options. The window was glass paned, screened, and barred on the outside. Not promising. I turned my attention to the door knob. Firmly screwed in place. I dug in my pockets and was disappointed to find I had no coins that might function as a screwdriver. Next stop was the door hinges. They were painted over, and wouldn’t budge. The one tool I had on hand, a toilet plunger, seemed unlikely to help me extricate myself.  Just when I was starting to think about the most comfortable way to sleep in the tiny room, my coworker came to check on me—she had heard my struggles with the lock on her way out. She unlocked me from the outside, we posted a sign with a dire warning against locking the door, and I went on my way convinced that this was one more reason to pee as rarely as possible.   

Why fix it when you can make money off it?

The traffic light at the main intersection in Tamale is currently broken, at least for some directions. The police were there yesterday. Rather than directing traffic, they were arresting and extorting money from motorists who entered the intersection at the wrong time. 

The broken light appears to be a boon to the police. My guess is it will be a while before it gets fixed.