Fufu short clip (since the link failed)

Risky business, pounding fufu :)

Sweating like a pregnant fish

Ghanaians love to dance. I have already mentioned this before, but it is definitely worth mentioning again: Ghanaians love to dance. Love. To dance. Big time. Preferably on loud music and preferably just a little bit too loud for the speakers used (resulting in metallic croaky sounding loud music...). Hands, feet, bums, hips, heads, and knees, anything wiggles and twists. Bending and turning in places where I definitely don’t have any joints that I know of.

By now you might be picturing a happy moving young crowd during a night out at your own town, but it doesn’t even come close to the average Dutch student-boy pointing his index fingers in a diagonal up and down motion. This is actual dancing. No accidental moves or drunk jumping up and down, but breath-taking amazing hip twisting and original moves matching the words and typical rhythm of a song (mostly ‘Azonto’ or ‘High life’). And all of this is drenched with sincere and infectious enjoyment.

Friday, two weeks ago, we had a good-bye party of a Canadian girl that lived in Accra for quite some time. She had made some good local friends and managed to arrange some large speakers and a DJ with her roommates, to send her off Ghanaian style: BBQ and dancing in the courtyard of the house she lived at, all night long. That night, when I came home and landed in my bed as tired and sore as from a good work-out, I just couldn’t stop smiling. After the initial staring at a group of dancing guys (so cool!), I just dived in and... well... danced! I might have gotten a bit carried away, but it just didn’t matter, because everybody was just having so much fun! Some guys tried to teach me some proper Azonto-moves (often vaguely inspired from daily motions like pounding fufu). By the end of the night I was happy that there wasn’t much light out, because I literally was soaked. Or as I heard several times that night: “No worries, we’re all sweating like a pregnant fish!” Clearly, Ghanaian dancing + Ghanaian heat + Ghanaian humidity = sweating like a pregnant fish. That saying is a keeper for sure.

The Saturday after my mom arrived in Accra. Sometimes you need an extra viewer to change the way you look at things, or to actually see things again. The popping of her head out of a tro-tro window to take in a street view (just turning it didn’t do the trick) or her big eyes of amazement to passers-by, made me realize how many things I already think of as ‘normal’.  I don’t really think of the messy, slum-like back-streets as shockingly poor anymore, that’s just how it is. But yes, it is very poor, compared to Europe. But for some reason it is also much more nuanced. In a dusty (mainly because of the unpaved roads and the Hamatan, sandy hot wind from the Sahara), smelly (open sewers, sweat), and polluted (no waste pick-up system, too many old cars) city like Accra, the 20-80 rule reigns. This rule of thumb, often used for input of students during schooling, argues that for an 80% result, you need 20% of the effort. To add the additional 20% of the result (to make it 100%) you need 80% more effort. I really think that in Accra it is just not worth the time and the money to keep things looking nice. Within a day colours are faded by the sun and everything is covered in dust. Why spend money on your house to make it look nice, if you can do ten times more with that same money when it comes to fancy clothes, gadgets, and activities? Big, nice houses is just something for the really really rich.

This was one of the reasons why in the beginning I couldn’t really tell if someone was poor or rich, or where on the scale in between. The same people living in these back streets were the ones owning a blackberry and a giant sound system, as well as the ones going to a beach with 10GHC entrance fee during the weekend (which is quite a lot!). It just doesn’t really matter where you sleep, as long as you have somewhere to sleep, eat, and wash yourself. Happiness does not depend on having a shower, a bucket will do just fine. When these basic things are out of reach however, yes, then it really starts being difficult.

Of course, I have the luxury of living in a nice house and having everything I need quite easily available. And I already get annoyed when we don’t have internet for example (I am embarrassed to say, but I am slightly depending on it!). Our very regular water and power cuts lead to the discussion which of the two was worse. The conclusion: both are okay, as long as you know when it happens and it doesn’t last too long. Unfortunately Ghanaians don’t stick to time the way we do, so even if there is a schedule for the power-cuts in Accra, they never stick to it. Oh well... it is just the best excuse for not working and just sitting in front of our house with the rest of the street. Sorry, we had ‘lights-off’!

In between sight-seeing with my mom (which she also actually did on her own for a part of the day! Very adventurous of her!) I actually had a very busy week. My research-assistant Muni (who has been a great great help to me, not just by translating, but also to get things to happen) had to go back to her regular job somewhere way up in the north-east this Saturday, so we basically had to fit all data collection in this one week! This meant interviewing like crazy, and even getting the focus group discussion organized.

That morning of the group discussion was a whole lot of Ghana at once. I asked the women who agreed to participate in the group discussion to come at 8:30 am (quite a normal time here, live starts very early). Around 9:15 the first one showed up. After several reminder calls, two other women showed up between 9:30 and 10:30, after which the other four (“yes, yes, I’m coming! I am on my way!”) decided to not answer their phones anymore and not show up at all. Apparently saying “no” is just too difficult... So I decided to not waste any more time of the three women that came and recruited three more women in their first trimester from the antenatal care. Luckily they agreed on participating... The funny thing was that I felt so guilty for wasting the time of the three women that did come, but they were not surprised at all, just waiting around, blankly staring away, switching to the “low-energy”-mode that Ghanaians have made to an art. Imagine doing that in Holland!

The group discussion was very interesting, and definitely gave me a lot of information (the small stroopwafels and cold water kept the opinions flowing...). I am very much looking forward to analysing my data, because I really think the vulnerability of pregnant women here in Ghana is far greater than I even expected! Starting a clinical trial here seems almost unethical! Anyway, hopefully I can come with some good advice for medical researchers... (For those of you who still are not quite sure what I was researching again, I’ll go into that a bit more next time ;))

After finishing all this (unbelievable!) I headed out with my mom towards Cape Coast and Elmina, where we had a very nice weekend together exploring and relaxing. It took me some time to wind down the first day... Did I really just do my whole data collection in less than two weeks...?! But it was really nice to hang out with my mom, showing her around in this interesting country.

Yet again I’ve managed to write a long post... (I hope you manage to read up to this point!) and I didn’t even talk about:

... the pig family that randomly walked by on the beach

... the fact that my mom really took my advice of talking to all the taxi drivers at heart, which resulted in her hearing the most interesting life stories

... including one of a guy wanting to write a book on how to life your life by acting not waiting :) which would definitely change Ghana for good...

... that I bought fabric and got a dress and skirt made! Can’t wait to see the results

... that I pounded fufu with Sandra (a girl I met through church, who lives in one of the back streets), which basically was a joint venture with her neighbours, some lost chickens, and the beats of “chop my money” in the background

... that I’m surprised that we don’t have more fufu-pounding-accidents coming in at the ER, like crushed hands

... that adultery is such a common thing here, that it has been a major topic with the women in church already almost every Sunday (what to do if your husband...)

... that I have a double identity here (both Geerte, which is impossible for Ghanaians, and Christine). What’s in a name, right?

... that I am very much looking forward to actually working at the labour ward and the obstetric operation theatre the coming weeks

and

... that ‘God is wonderful tea’

Big hug!!

(ps. don't forget to scroll down for pictures, click to enlarge, and the fufu movie!)

My street at dusk

The women at church... and me :)

Walking in Sandra's neighbourhood

Sandra's room is in the house on the left

Mama picking Maringa leaves (very very nutritious!) with Sandra land lady

Making banku

The beautiful Sandra starting the pounding of plantain for the fufu

Me, trying not to get hit by the pounding stick whilst putting the fufu under it...

http://www.youtube.com/watch?feature=player_embedded&v=AiQ7eeiNf2U

(fufu movie)

The result: fufu with groundnut (=peanut) soup

The women waiting for antenatal care at the clinic

Muni ready for interviewing

One of the midwifes in action

The mother of a friend from church, who sells red-red (beans with fried plantain) near the hospital, yum!

Exploring Elmina

The simple joy of a tire :)

Mom making friends

The upward view from the courtyard where the slave trader chose a woman for one night at Elmina Castle

Cape coast... me in action

Elmina harbour

Showing my picture to some kids at Ada (from last blog)

Sewers...

Accra's sewer on my way to the hospital...

Lighthouse of Jamestown (Accra)

Jamestown 'harbour' (Accra)

TSsst!!

Dry, savannah-like, deserted no-mans land reaching to the horizon. When you imagine being on the road in Africa that is what most of us would imagine. Give or take the occasional elephant or mud-hut village of course.  This weekend Karin and I went on a little trip again, this time to the east from Accra, to Ada Foah, a little town right on the edge of land were the Volta river flows into the sea. The view from my window in the crowded tro-tro was just like Africa how you imagine it: dry, savannah-like land as far as the eye can see, with the occasional (dry) tree and village in the distance. However, surprisingly, it wasn’t no-mans land. Frequently no more than a half built structure of a building, or a fence (typically only one-sided) with a ‘keep-off’ sign, indicated that this piece of land in the middle of nowhere was property of ‘The Frimpong family’ or ‘University College Central’. No neighbours, no near-by village, no water, no nothing, just some lonely bricks piled up in a brief spree of ambition. I really wonder what people thought when buying that land and building that foundation, really... why there? Or actually just: why?

A four square meter wooden shack called ‘God’s First Fashion Centre’ was the first thing that indicated that we were coming near Ada. Ada is basically a quiet fishermen town with almost more churches than streets. We stayed in a small two-person hut near the ocean, on the quiet side of town. It is funny how small things like a shower (one I could actually stand under!) with good strong water flow can be so satisfactory. Saturday we spent pedalling a wooden canoe (which we rented from a fisherman at the jetty) around one of the islands in the river delta. The fact that we wanted to paddle ourselves was quite amusing to the guy (those crazy obruni’s!) but we could tell we weren’t the first tourists to have asked for that. The area was beautiful! Small villages on the waterside with stark naked children enthusiastically waving at us while having their daily bath in the river, fisherman pulling the nets back in, quiet mangrove greenland with some birds, and a group of jumping silver fishes in our track, sparkling in the sunlight. To finish off we headed to a beach hut playing music, where we found a bunch of other tourists scattered out on the beach, as well as local Ghanaians on a weekend trip. Quite a contrast after our morning stroll through the almost deserted town!

But before you start thinking I do nothing but exploring Ghana, a bit more on my weekdays. The last couple of weeks I’ve been going to the antenatal care clinic. Because I don’t have full clearance yet from the ERC (I still need to get my informed-consent-form translated, but it’s all going on African Time), I couldn’t really start interviewing women at the antenatal clinic yet. However, since my interviews with the staff are in English, I figured that it wouldn’t harm just to start with that. So after a couple of days of working along with the midwifes to do the standard check-ups of pregnant women and new-borns, depending on the day, (of course combined with plenty of observation...) I really started to get to know the midwifes and asked some of them for an interview. Although it was quite difficult to really go deep during the interviews (the whole concept of a clinical trial is new to them), I am quite happy with the info I have so far. I am looking forward to doing interviews with the pregnant women though... Although that will be even more difficult since I will be working with a local female translator/research-assistant (sounds very official) and I won’t be able to really guide the interview. The good part of the research-assistant is the fact that she will also do the transcribing and translation of the recordings (which is an incredible boring and annoying job). Yay!

Besides the normal working time at the ANC, there are some other activities that I just spontaneously take part in. Last week for example there was a neonatal resuscitation training for the midwifes (they don’t have the luxury of a paediatrician on-call). Very good for refreshing my memory, but also interesting to observe. The trainer was one of the midwifes that I did the training with during one of my first weeks, organized by an UK/USA NGO. So I knew that she had learned that some things (like sucking-out the babies throat and nose with a non-sterile balloon suck-thingy after all deliveries) were proven useless or even harmful (increasing the risk of laceration of the airway because of the deepness they do it, as well as increasing the risk of infection because if the dirt that accumulates in the balloon), but she somehow managed to say that new knowledge within the same sentence that she advised everybody to still suck-out all neonates! Old habits die hard, I guess.

This week I get to go to a one-day Gynaecology and Obstetric Millennium Development Goals Conference in a fancy hotel here in Accra, definitely looking forward to that!

It is interesting how fast you adapt to the way things go somewhere. While during the first weeks my hands were itching to give the once white coats of the doctors a good scrub to make them white again instead of the redish-dusty-grey they are, I today noticed that my own white coat is not as clean as it used to be either. I realise that I remind the midwife when she forgets to ask the obligatory donation of blood by a family member of a new pregnant client (the only way they can keep the blood bank running). Also, I’m not surprised anymore when the midwife gets a bit of extra money pushed in her hand after the consult, or on the other hand the request for money when some kind of examination is performed. Not only is every speculum (‘eendenbek’) bought/rented for a vaginal examination, also the hospital maternal health folder is paid in cash, as well as the plastic cover for the physical exam bench, which the patient is supposed to bring everywhere she goes in the hospital. Medicine needed in the hospital needs to be fetched by a relative at a big pharmacy (sometimes a 20 min tro-tro drive away, longer when the traffic is bad). All this, even with some sort of general health insurance at place.

Also more wide-ranging things, like saying ‘sorry’ for things you can do nothing about, but are just generally bad luck. The other day I scraped my knee in a tro-tro (my long legs never match the bench size) and when a lady in the back of the bus saw the tiny drop of blood on my knee while I was climbing out of the tro she prodded my shoulder, and very genuinely said: “I’m sorry!”. Like there was anything she could have done about it! And this is just one of the examples, it could have also been that the battery of my phone died (“I’m sorry!”) or that the stapler ran out of staplers (“I’m sorry!”).

Nevertheless, there are some things I can not get used to. Like the hissing sound people make here to get someone’s attention. It’s a mixture between the sound someone makes when rolling their eyes at something (‘tssss...’), when you are unpleased with something (‘tssss.... you must be kidding me!’), when a constructor is trying to draw the attention of a hotty (‘psst! Lekker ding!’), or when someone is secretly trying to sell you something on the street (like in India the “tsst! Madam! You want grass?”). With me it is just associated with indignity or something, I don’t know, but if I use it (which unfortunately is quite necessary sometimes) I try to compromise it with a very big and kind smile... which must seem hilarious for Ghanaians. The Weird Wide-grinning Whispering White Woman. Yup, that’s me.

Finally I just have to point out that this has been my first month in Ghana already (yes! That long already, time flies!). I’m looking forward to the rest!

Take care and until next time!

Ps. I’ll post some pictures that actually have me on them later. Since I’m usually the one behind the camera those are on Karin’s camera...

Meat is also sold at the market...

Well? Are you?

Karin in action

Walking through a sugar cane plantation with two French girls we met

Big pots used for rum made out of the sugar cane

Sister Love :)

After 'landing' our canoe was soon confiscated by some boys

Striking a pose...

Same, Same, But Different

“Accra-Accra-Accraccraccraccracrracrra!” Like a Tibetan monk chanting his daily mantra the tro-tro boys shout their cryptic description of the direction the small busses for about 12-15 people are heading to. It’s either that or one of their hand movements you need to decipher to be able to hop on the right one. It’s always a surprise which route they take, depending on the driver’s opinion of a short-cut, or a detour to avoid the dusty, smelly, and always busy traffic jams of Accra. The route is usually neither faster nor shorter, but oh well... it’s African time!

I like sitting in these daredevil minivans, honking their horn with every move they make. You never know who or what you will get to sit next to. My experience so far has included a gigantic bowl of dried fish, the freshly baked bread from the big (but well hidden!) bakery in my street, cute school kids in matching uniforms, and the colourful dressed mothers with their babies tied on their backs. Big brown eyes, wide open with an expression of horror mixed with astonishment and wonder, sometimes continue to stare at me without blinking throughout the full journey. I can just see these little infants marvel at the sight of such a white person. What is it? It looks like a human, but it is so... different!

Besides the little children tied to the backs of their mother, another common sight is people carrying things on their head. Or, as I should say, people carrying everything on their head. That’s just how it is done; if you need to carry something, it is on your head. Big plates or bowls piled up with matchboxes, eggs, little (or large!) glass boxes containing all kinds of baked snacks, drinks, dried fish, cloth, bread, toilet paper packs, car parts (!), belts, kitchen equipment, shoes, really anything! It is like a one-(wo)man-shop on legs, literally! I am amazed by the weight people manage to carry, always without using their hands. I even saw a woman carrying a whole wooden bench one day! An anthropologist wrote a book on the concept of ‘balance’ in the Ghanaian society, a very anthropological thing to do I must say, but after my first weeks here I can really agree with the statement that balance is an essential part of becoming an adult here, on so many different levels.

Another aspect of Ghanaian society is the right-in-your-face, unavoidable subject of religion. Whether it is the painted remarks on the taxi’s and tro-tro’s, or the shop names: God is involved in everything. My favourites so far include a tro-tro with “Guarded by angels – KEEP OFF” on the back, a taxi with “JESUS IS MINE” (well, good to know fellow!), and a barber shop named ‘Because Of You I Cut My Hair”. Also a tro-tro more than ready for the car-graveyard with ‘Salvation is near!’ on the back definitely made me smile.

Every morning at the handing over of the shifts in the hospital we start with a prayer. For a moment the almost universal arrogance of doctors is diminished to humble words of giving thanks and asking for guidance. It might be a routine for many people here, but I really appreciate this moment that the exclusive, elite medical profession seems to admit its boundaries.

I would love to describe the intense, crowded, sweaty, smelly, noisy, messy insides of the hospital to you all, but I just don’t know where to start yet. It is just so... African :)! To some of you I told the story of a delivery I did during my rotations in Holland of a Caribbean woman who almost strangled her husband during her labour, well, imagine 40 of these very expressive, loud, passionate women in one half-open corridor and you might grasp the sight of the female ward in the hospital I work at. They’re always low on staff, low on space, and low on time. The hospital has over 11000 deliveries a year, eleven thousand! I’m starting to find my way at the Antenatal Clinic (ANC; where most of my research will be done), but I will very surely have plenty of obstacles to climb before I can start doing my interviews. Good news from the Ethics Committee however: with some minor additions to my proposal (like translation of the informed consent form in Twi, which I already expected) I have an approval! Yay!

The last two days I’ve been participating (or maybe I should say observing) a triage training for midwifes by a group of UK/USA midwifes. There is a lot happening at the hospital, simple ideas like colour coded wristband indicating medical urgency can result in a better flow and more efficient care with large impact. It is unbelievable how many people know about but just accept a failing system!

I should really do more regular updates because I just have so much to tell! Last week I met up with some local youth of the Church of Jesus Christ of Latter Day Saints (the church I go to in Holland too, which is enormous here!) and I just really realised I don’t have any internal reference (is that even an English expression?) for Ghana. I just don’t know where to place things, people and remarks! It really is a cool opportunity for me to actually get to know local people from all layers of society and my age through the church. But after my first night hanging out with them at the small one-room house (no kitchen, a shared bathroom outside) of one of the girls my age, I just was overwhelmed with impressions. There was so much to observe! So many questions that came to mind when talking to them... It is of course very generalizing to say, but after travelling (and living) in quite some countries in Asia, I could quite easily grasp new and different cultures there, like cultures in Europe are very different but similar too. Here in Ghana however, there are so many similarities that seem to be part of life in lower-middle income countries (the street/cityview, the smells, the approach to life, the tension between old and new, the great contrasts between rich and poor, etc) but the culture is so very very different. Not very surprising, you could say, but I just really liked the realisation I had that this was a different kind of ‘different’ yet again! A kind of ‘different’ I really will have to slowly unravel...

Throughout the coming weeks I will surely tell more about this unravelling of Ghanaian culture, but for now I better stick with an other short list with some additional experiences during the last week. Again, I don’t want to overwhelm you with my endless thoughts and contemplations... Some other experiences I had this week:

-      Having my first weekend away which included wandering through an old slave-trading fort and the harbour town of Cape-Coast

-       Walking on canopy bridges in Kakum National Park, one of Ghana’s last tropical forests (a bit of a tourist trap, but fun anyway)

-       Relaxing big time at a place called ‘The Stumble Inn’ at the coast near Elmina, with the most quiet, beautiful, palm tree-lined beach possible. Including a late night camp fire and a funny game with other travellers (was actually missing my guitar there! Good incentive to get me playing again maybe?)

-       Having fresh mango, pineapple, banana, passion fruit and watermelon in all different combinations for breakfast every day (oh the good life!)

-       Spotting my first of many ‘Obruni Hunters’... the opposite version of sex-tourism in Asia (white middle-aged women with young black guys as apposed to white middle-aged men and Asian women...). I heard there is a new documentary out in the Netherlands now on this topic...

-       Cheering for ‘The Black Stars of Ghana’ (aka the national football team) in the tro-tro on the way back from Cape Coast (radio-football reporting is an art... a difficult art for the over-passionate Ghanaians; listening to the volume and excitement of the reporter it was like the Ghanaians were about to score all the time...)

-       Having regular electricity black-outs due to a current lack of sufficient power in Ghana because of some broken connection coming from Togo or something...

-       Hearing that my mom booked a flight to come visit me halfway through February (how cool is she!)

-       Hanging out (of course with loads of chatting and good food) with my Utrecht roomie Joyce in Accra, which made me call Accra Utrecht by accident several times

-       Learning that my Ghanaian name is Efia, since I am born on a Friday (who knew?)

Good times for sure! Big hug!

Makola Market - Accra

Some faces just ask for a picture :)

Example sheets for the tailors

Karin making new friends

It's all about balance

Dried fish everywhere!

Cape Coast Castle and beach

Streetview at Cape Coast

Cape Coast fishers heading back home

View from the castle

Women slave dungeons at Cape Coast Castle

Drying fish in the sun

Fixing the nets