The STC bus is superior to many forms of transportation in West Africa, including the Metro Mass bus, the tro-tro, the Benz Bus, the sept-place, and the one-speed bicycle. However, it is vastly inferior to Antrak Air, which, as my friends like to call and remind me while I am on the bus, takes 1 hour to go from Tamale to Accra and serves tuna fish sandwiches. My tips for a pleasant trip on the STC bus:
1. Plan for a 15 hour trip; expect the bus to leave 2-4 hours late. 2. Dress for the air con. During the day, the air conditioning will be sufficient from keeping the bus from getting unbearably warm. At night, the air conditioning will be sufficient to cause hypothermia in penguins. 3. Bring ear plugs or headphones. Or learn to love very loud Nigerian movies. 4. Plan what you eat and drink around rest stops. The bus will usually stop 3 times, each stop about 4 hours apart. The restrooms get progressively worse as you go north. 5. Lean back. Avoid sitting in front of a grumpy lady who hits you on the head every time you try to recline an inch, despite the fact that her chair is in the lap of the person behind her. 5. Make it a party. Your "friend" calls to tell you he's having a steak dinner with a glass of bourbon? I've got a 1.5L water bottle of gin and juice, and bag of popcorn, so there!
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In Ghana, large plastic bags, printed with plaid or otherdesigns, are prolific. The bags arecalled “Ghana Must Go” bags. I haveasked numerous Ghanaians why they are called this. They reply that Nigerians call them that, forunknown reasons. I finally learned thatthe name originates from Nigeria’s political turmoil in 1983, when manyGhanaians fled Nigeria. They hastilypacked their things in these bags.
Upon discovering these bags, I decided that they would be agood inexpensive option to carry our surveys, and dispatched the field managersto buy a couple for each of their offices. The tough field managers, who are a sophisticated combination of book-smartand street-smart, came back with bags printed with cartoon bears and cartoonpigs. Secretly amused, I asked themwhether they thought the print on the bags reflected the seriousness and professionalismof IPA. The next day a third bagappeared bearing cartoon Mickey Mouse. The bags held up during the course of the surveying,ferrying blank surveys to the field and completed surveys back to Tamale. StuffNigerianPeopleLike.com claims a GhanaMust Go can carry a child and his dog for miles. When I took our complete batch of surveys toAccra, the bags weighed in at 35 kilo per bag, which unfortunately, seems to bemore than a child-dog combo. My bags weredestroyed in one bus trip to Accra. To add injury to insult, plastic handles onthe bags chafed my palms, which have been peeling unattractively for weeksdespite copious amounts of shea butter. The surveys ultimately made it to the data team, whopolitely did not comment on the layers of dust the surveys had acquired duringtheir sojourn through the Northern Region. The lesson is that while I highly recommendGhana Must Gos for children, dogs, and objects with high volume-to-mass ratios,I do not recommend them for objects with density greater than or equal to adusty IPA survey. If you are like me, you know at least one person who loves to get bumped on flights. That traveler connives to travel on busy days, when airplanes are most likely to get over-booked, so that he or she can receive a sizeable travel voucher or free ticket in exchange for taking the next flight.
Recognizing that market exists, Delta is planning to start allowing travelers to bid for bumps. On overbooked flights, passengers would be allowed to submit the price they would be willing to accept in exchange for taking a later flight. Passengers with the lowest bids would be selected to be bumped first. I am curious to see (and the article doesn't clarify) whether Delta will pay each passenger the voucher amount that he or she bid, or whether Delta will pay each passenger the voucher amount bid by the last passenger to be bumped. I am also curious to see how quickly information about winning bid prices gets out, and how the information affects bidding strategies of passengers. I am also curious to see how long it will take before a flight of passengers successfully games the auction... Sounds like a good research project for an auction theorist! Operating in four regions, the logistics of this project have been challenging. The timing of our survey made it worse, as the wet season is a bad time for roads. It has been difficult for our management team to get to our field offices, and it has been difficult for our surveyors to get to some respondents.
Bole was the most difficult location to get to. Normally it’s a 5 hour ride on Metro Bus. Shortly after our survey began, they closed the road between Tamale and Bole, and routed transportation through Kantampo. This meant that to get to Bole, instead of a 5 hour ride, it was now an 8 hour ride, with two bus transfers. And the bus ALWAYS left late. Salaga had the most problems with inaccessible respondents. At one point, the survey team left to travel to a community, got nearly there before the road became impassable, and had to turn back. A wasted day. Salaga also had some respondents accessible only by boat, but high waters made the journey too dangerous. Since these respondents would likely be unable to get the treatment we are testing anyway, we replaced them in the sample. Salaga wasn’t always a breeze to get to, either. The road seemed to disintegrate a little more every trip I made there. The last trip there, Metro Bus wasn’t running because of road conditions, so I took a tro-tro. I estimate about 10% of the road was water on that trip. We were traveling at night, and there was a rain storm. Since the tro-tro had no glass in the windows, I spent the duration of the storm holding a plastic sheet up to shield myself and fellow passengers from the rain. After the rain stopped, the challenges continued, as all that rain flooded the road. At times it seemed like we were driving in a river. At one point, we had to get out of the tro-tro and trek through 100 meters of knee-deep water, so that the tro-tro could go through empty to avoid getting stuck in the mud. A few of the Ghanaians took great fun from telling me “Welcome to Africa!” Ironically, because I had traveled that road eight times in the past month, I was probably less surprised by the road conditions than they were. One thing my survey sought to measure was the respondent’s perceived risk of falling ill. We expected this to be tricky, because many of the respondents are not highly number literate, and most have no concept of probability. This was easily the most challenging part of our survey to design.
We tried to model our question after surveys that had been done in other developing economies, as detailed in Delevande, Gine and McKenzie. These surveys asked respondents to allocate piles of stones to different pots, depending on how likely they thought different amounts of rainfall were. The advantage of this is that the respondent does not even need to be able to count, he or she can just compare quantities, and see that one is larger. Also, the respondent can easily make marginal changes, moving a few stones to a different pot, if you change the conditions of the questions slightly. We adapted our questions to ask respondents the probability they would get sick over the next month. What sounded like a simple and elegant model turned out to be an incredible struggle. The responses we got failed basic logic tests as often as not; for example, respondents would predict a higher risk of getting sick once in the next month than once in the next year. After rounds and rounds of piloting, and consulting everyone we could think of, we identified the major problems, and attempted to address them: 1. People don’t like to say they will get sick, because they think it will then happen. We addressed this by changing our question to ask about the probability someone as healthy as them would get sick over the next month. This seemed to help. 2. “Chance” and “likelihood” don’t translate well in Dagbani. We did our best to write the questions in English so that they would be as simple as possible, and then carefully worked through the Dagbani to find the clearest translation. 3. People have little concept of marginal changes in probability. In northern Ghana, something is either certain to happen, certain not to happen, or may happen (50-50). Our weather reports, forecasting 40% chance of rain, would make no sense here. Conceptualizing one thing as more likely than another, or conceptualizing small changes in risk, is completely counter-intuitive. We never completely solved this problem. 4. People don’t like stones. Natural objects, like stones or beans, are associated with witches’ fortune-telling, which people don’t like. And here we were asking them to predict future sickness with stones. We switched to bottle caps, which as a man-made object, are less threatening. My friends in Tamale drank beer very diligently and enthusiastically in the weeks leading up to my survey in order to provide the 720 bottle tops I needed. As a result of continuing problems with #3, this section proved to be the most difficult in our survey. It was only a few questions long, but the time it took to explain the concept, go through examples with the respondent, and work through the questions added up to nearly 30 minutes, almost a third of the total survey. This week, my team will be completing our baseline survey. This is quite a landmark achievement for us. We pioneered a team structure my organization has not used in this region before, relying on talented temporary staff to serve as field managers overseeing survey operations in each of the four regions we worked in. The project manager and I rotated between the locations, monitoring progress and paying surveyor salaries. We administered a 1.5 hour survey to 1500 respondents, in at least 7 languages, using 60 surveyors. We did it in a month, not counting our piloting and census. During the survey, I have taken a hiatus from blogging, despite the fact that my survey has generated some material worth sharing. For the next couple weeks, expect to see stories about my surveying experience: the Survey Chronicles. Last week, I managed to get an infected scratched cornea in my right eye. I am now doing much better, and my doctors are predicting a full recovery, but the process I went through to obtain treatment offers a great deal of insight into medical care in Ghana. Here is the story:
On Sunday evening, what I had thought was typical contact lens irritation became very red and painful, to the point where I slept with an ice pack on my eye. By Monday morning, I realized that I likely had either a scratched cornea or an eye infection. I took a taxi to KABSAD Scientific Hospital, which is not actually a hospital, but rather a small clinic favored by ex-pats in Tamale because it is fairly clean, admits cash-and-carry patients with relatively little paperwork, has an actual MD on staff, and will let you do your own malaria tests. I arrived at KABSAD at 8am, and was informed that the doctor would be there any minute, and then he would decide whether they could help me, or whether to refer me to Tamale Teaching Hospital. An hour later, the doctor had still not arrived at KABSAD, so I took a cab to Tamale Teaching Hospital. I wandered around the hospital with one eye open until I found the eye clinic. They informed me that I needed to get a folder from the OPD before they could help me. I wandered around the hospital with one eye open until I found the OPD (which, by the way, I still do not know what stands for.) The OPD appears to be the single biggest bottleneck in the Teaching Hospital’s services. Everyone who is there for anything must first go to the OPD. There, they must supply personal information, including name, age, phone number, address, and religion (which sounds completely irrelevant, but as you will find out, is not.) You must also tell them what services you will use—before you ever get a diagnosis—so you can pay for them. Luckily for me, I knew I needed a consultation at the eye clinic. Also luckily for me, I happened to befriend an off-duty male nurse named Awal. Awal helped me procure my folder and pay for my eye consultation. Awal then took me back to the eye clinic. Before seeing the ophthalmologist, I had to first see the eye sight nurse, who made me read off letters on an eye chart, and tsk-tsked at my poor vision, apparently oblivious to the fact that my right eye was red as a tomato, barely open, and dripping tears all over her precious eye paddle. Next I got to visit the “eye open”, which quickly became my favorite stop, because an elderly nurse, exuding competence and humming church hymns, put soothing drops in my eye that made me feel considerably more comfortable. Finally I got to see the ophthalmologist, who looked in my eye, then sent me back to the “eye open”. Again I got soothing drops, but this time the humming nurse betrayed me by following them up by putting a stick in my eye. The stick must have had some type of dye on it, because after that, three nurses, Awal, and the ophthalmologist gathered around to look at my eye and make interested-sounding noises. They then bustled me out of the “eye open” and back to the ophthalmologist’s room. The ophthalmologist explained that my eye was cut; that I had an ulcer in it. I interpreted this to mean that I had a scratched cornea, which I took to be good news, because although they are painful, they usually heal quickly and without complication. “Good,” I said, “so it is not infected?” “No,” said the ophthalmologist, “it is also infected. We will give you medicine.” Of course, I then had to first pay for the medicine, and then go get the medicine, and then bring it back to the “eye open.” At the “eye open”, the humming nurse applied antibiotic drops and a soothing ointment, and then put an enormous bandage over my eye. The bandage didn’t quite succeed at keeping my eye completely shut; I do not think the nurse was used to working with people whose noses are quite as pointy as mine. I left feeling a bit better, but with limited vision, at 12:30pm. I should note that, as long as these steps took, two things enabled me to care more quickly than the average Ghanaian would have. First, I was paying cash for the services, not using health insurance, which would have entailed more paperwork and longer lines. Second, Awal somehow managed to get me to the head of every line, from the eye sight clinic, to the “eye open”, to the ophthalmologist’s office, to the pharmacy. I felt a little bit guilty about this, but at the time my eye hurt badly enough that I didn’t really care. In retrospect, none of the other patients appeared to have conditions in need of immediate attention—the only person who objected to my speedy admission was a man concerned about missing the bus. I do wonder how someone with a true eye emergency would fare: would a guy with a stick stuck in his eye have to wait in line to read an eye chart before seeing a physician? The first day after my eye was treated was generally miserable. I had been given pain medication, which turned out to be ibuprofen. I had been holding out hope for codeine. I seriously considered treating myself in the “traditional” way, and if I’d had some vodka on hand, I probably would have put away a few shots. Fortunately, my body was being cooperative after a stressful day, and I was able to sleep through the worst of it. The next morning, the pain had improved, the humming nurse changed my dressings at the hospital, and I shuffled back home to go back to sleep. My friend Kris brought me some groceries, and despite my reduced depth perception, I was able to cook a fine dinner of poached guinea fowl eggs, toast, cheese, and boiled carrots with no mishaps. . The next morning found me sitting back in the “eye open”, as the humming nurse removed the bandages from my eye. Again, two nurses, Awal, and the ophthalmologist peered at my eye, and made pleased-sounding noises. However, although my eye looked better, it wasn’t doing so well at seeing. When I closed my good eye, I found that looking through my right eye was like looking through a fogged glass—I could see light and some shapes, but little else. I asked the ophthalmologist why my vision was blurred. He peered at my eye, and declared I had some scarring. I asked if it would improve, and he said that it might, as it healed. I asked if anything could be done. The humming nurse flipped through my chart, and noted that I was Christian. “You can go to any church in Tamale,” she said, “and they will pray for your eye.” I took that as my cue to go not to church, but to Accra. (Accra has taken on mythic proportions to me living in Tamale. In Accra, you can buy sushi, blue cheese, a new eye, and possibly baby unicorns. Since the next-day flight to Accra was full, my boss arranged for me to drive to Accra with several of the PhD researchers who were visiting Tamale and were planning to drive back to Accra starting that afternoon. We stayed the night in Kumasi, at a very nice hotel. One night cost me the equivalent of one month’s rent in Tamale. I was actually fine with that, since it was still considerably less than the cost of an airplane ticket. However, I was a bit annoyed when the AC in my room didn’t work. I slept fine anyway, but in retaliation, I stole the soap. I arrived the next day in Accra. By the time I was able to hire a taxi to take me to the well-reputed Emmanuel Eye Clinic, it was 2:30. To my surprise, the clinic was closed, except for a receptionist who booked me an appointment for the next day: the doctors only work in the morning. Since my eye sight had improved over the past day, I was not too concerned about the wait, but I made a note to tell my father that if he ever gets tired of being on call on holidays and weekends, he can come to Ghana, work half a day, five days a week, and drive a very swanky car. (Note: no one has ever had fewer ambitions to drive a swanky car than my father. Maybe a swanky bicycle.) I returned to the clinic the next day at 10am. Emmanuel Eye Clinic is very efficient for those who make appointments, but appointments seem to make up only a small share of the clientele. Getting in to see the ophthalmologist, getting my eye dilated, and picking up my new medications took only a couple hours. The news was good: the ophthalmologist said that the scarring on my eye would not obscure my vision, and that in time all of my sight should return, although I might have some permanent light sensitivity. This news was a considerable relief. I did have one further complication: my eye remained dilated for about 50 hours (3 to 4 is the norm). Apparently this happens to some people, and it is more common among those with light colored eyes like mine. Still, I wonder if the eye clinic uses a particularly strong dilator, since most of their clients have very dark eyes. I returned home to Tamale after taking a day to relax in Accra. My vision in my right eye is still a bit blurry, but I am continuing with my medications, and it seems to be slowly improving. I seem to have been lucky in a number of things: the location of the scarring on my eye, the fact that I know a good deal about health care providers in Tamale as a result of my research, and not least of all, my coworkers, friends and family who provided support for me: Jessica for getting me to Accra, Lana for checking in with me each day, Kris for bringing me food, Ryan for hosting me in Accra, and my parents for taking my calls at ungodly hours of the night. Thanks for everything! One of the health care providers I visited today offered to sell me his hospital. I told him that we would not be able to run it as well as he could.
On the other hand, my organization has already acquired a monkey named George for 8 cedis (about $5), so why not add a hospital to our collection? Saturday night I attended a Ghanaian beauty pageant with some friends. The first thing I learned is that events here never start on time. The pageant was scheduled to start at 8; we got there at 9, and we waited an hour and a half before it got started.
The pageant was put on by the local technology school's marketing department; the contestants were students in the department. The pageant provided an interesting overview of local performance groups, as there were filler acts in between the pageant events. The pageant itself comprised a group dance, a talent portion, and a question and answer section. The talents were mostly dancing, except one contestant who acted out a dialog. Based on the quality of the various filler acts, dancing seems to be the highlight of the local performance arts. My favorite was the contestant who donned a fedora and did a Michael Jackson dance; another contestant performed a traditional dance that was quite good. The question and answer portion was the most interesting. The questions would have fried the brains and nerves of any U.S. pageant contestant. Here were a few of them: 1. What do you think about female genital mutilation? 2. If your 10-year-old sister were raped by your uncle, what would you do? 3. Imagine that the day before your wedding, your fiancé finds out he is HIV positive. What would you do? 4. Do you think Ghana's domestic violence law is effective? The contestants gave short but well-reasoned answers, and did not seem at all phased by them, while I and the other ex-pats were stunned at their intensity. I think this underscores how sheltered our lives are in the U.S.; these issues are realities for many young women in Ghana. In the end, the winner was contestant number 6. Apparently the judges' taste differed from mine, because I had not been especially impressed with her talent or answer. I was sad that the MJ girl did not place. However, my friend's host brother was delighted, because he had been smitten with her from the beginning of the pageant; the choice appeared to be popular with the crowd as well. All of the women were beautiful, talented and well-spoken, and should be proud of their academic achievement at the markas well. I am currently obsessed with change. Going to the market is an exercise in retaining as much small change as possible.
I was warned to jealously guard my one cedi notes and coins, but I did not realize how important this would be until I was trying to buy lunch the other day. I walked up and down the street, but no one could sell me fried cheese or avocados and give me change for my ten cedis. I was starved by the time I decided to go to the canteen and buy a full plate of jollof rice. Although my problem with small change is likely exacerbated by the disparity in income between me and most of the people living in Tamale (I take 100 cedis (about $70) out of the ATM at a time, where many people may earn only a few cedis a day), I believe the lack of small change is a problem for everyone. Many things are sold for less than 1 cedi, yet 10 cedi notes are prolific and coins are rare. I have heard there are businesses that will trade you 9 one cedi notes for your 10 cedi note. This problem may also be related to the recent re-denomination of the cedi; several years ago they chopped four zeros off the currency; what sold for 10000 cedis is now 1 cedi. |
About Liz
I have worked in economic policy and research in Washington, D.C. and Ghana. My husband and I recently moved to Guyana, where I am working for the Ministry of Finance. I like riding motorcycle, outdoor sports, foreign currencies, capybaras, and having opinions. Archives
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