A poster in the office of a TAMTAM partner organization
I’ve learned a bit more about ACTs since my previous post on them. A 2004 Institute of Medicine report called Saving Lives, Buying Time recommended subsidizing ACTs to make them affordable to those who need effective malaria medicines while using combination therapy to prevent resistance, or to “buy time” before malaria is resistant to this treatment, too. I had expected to find affordable ACTs here, but found that variety made by Novartis (Coartem) cost about $8.60 and the variety made by an Indian company (Lonart) cost $3.60. It turns out that the effort is just now rolling out, set to begin in July 2010. ACTs are now supposed to be 95% subsidized; it will be interesting to see if things change by August.
The chef of the family with whom we are staying recently got malaria and spent the money for Coartem. His Coartem box contained 18 tablets. His pharmacist instructed him to take one tablet at night and one in the morning every day for three days; fortunately Noel read the fine print that indicated that he was actually supposed to take three pills in the morning and three pills at night for three days. It is not hard to imagine how confusing those 18 pills would be to someone who could not read; an adult literacy rate of 65% in Ghana means that a lot of people who get malaria cannot read those instructions. It’s cool that a professor and classmate of mine are working a trial to determine if images explaining dosages result in improved adherence.
Noel's Coartem and its instructions
And then there is one of our friends, a Ghanaian man educated at prestigious universities in the United States. He finds bed nets uncomfortable and annoying but knows that malaria takes 7-10 days to manifest itself inside humans. His solution was to buy a bunch of Coartem in a country where it was subsidized by the government and to take some every two weeks. And when I say some I don’t mean the full course! As I explained in my previous post, not taking the full dose can allow malaria to develop resistance to the treatment. I can’t blame my friend and am myself guilty of not always following full courses of medicines. But it’s certainly a thought-provoking concept. Will making effective treatment affordable also lead to more misuse of the treatment? Will the Affordable Medicines Facility for malaria actually manage to “buy time” while “saving lives?”
Matt and I ventured into the endless bustle of Makola Market in downtown Accra yesterday. Piled next to each other along the sides of the streets are stands specializing in single items: suitcases; polo shirts; biscuits; radios; bras; vegetables; giant, edible land snails; sleeping mats; blenders; ladies’ purses; baby girls’ dresses; hot water heaters; sunglasses. Piled in front of the stands are people sitting on the ground offering whatever they can carry on their head that day, which is sometimes quite a lot! There are toothpastes, small packets of Blue Band margerine, stuffed animals, hairbrushes, bars of soap, Ghanaian flags, homemade baked goods, cloth, vegetables, and clothes donated by the Salvation Army.
Makola Market from above
It never ceases to amaze me how seamlessly the women and men here can effortlessly walk balancing items that easily amount to 20 or 30 pounds atop their heads; navigating Makola Market posed no obstacle to them. We joined streams of constantly moving people as they maneuvered around crumbled parts of the street, drainage ditches, and one another. We heard the frequent, harsh, high-pitched beeps to which all Nokia phones here seem to be preset for text messages. We experienced smells that varied as much as the items for sale. We got used to being beckoned with “abroni abroni!” with mixed sentiments of a desire to sell us things and a fascination with the only white people in the market. Children and teens, often with their own wares atop their heads, would run up to shake our hands and run away giggling. We laughed with one woman who grabbed at my dress and unexpectedly ended up untying my bow (fortunately decorative rather than functional).
It never ceases to amaze me how effortlessly the women and men here can walk while balancing items that easily amount to 20 or 30 pounds atop their heads; navigating Makola Market posed no obstacle to them. We joined streams of constantly moving people as they maneuvered around crumbled parts of the street, drainage ditches, van drivers backing up, and one another. We experienced smells as diverse as the items for sale. We heard the frequent, harsh, high-pitched beeps to which all Nokia phones here seem to be preset for text messages. We got used to being beckoned with “abroni abroni!” with mixed sentiments of a desire to sell us things and a fascination with the only white people in the market. Children and teens, often with their own wares atop their heads, would run up to shake our hands and run away giggling. We laughed with one woman who grabbed at my dress and unexpectedly ended up untying my bow (fortunately decorative rather than functional).
Each new intersection presented equally chaotic paths; though those familiar with the market claim that there is an order to its arrangement. We will see if we can deduce any of that today, as we now venture back with an aim – to find supplies for hanging bed nets!
For whom am I rooting tonight?
Well I will be happy no matter which team wins!
Here are some photos from the places where we watched the last two Ghana games…
First at a big, swanky place in Osu called Citizen Kofi.
Watching at Citizen Kofi
Next huddled around a small TV at a cabstand, amid about 30 men rooting for Ghana in various local dialects. (I think I’ve been in areas where people speak about 8 different languages since I have been here. It can change from one area of town to the next. It makes it tough to learn enough of each to communicate with people even to say hello, something that I would like to be able to do.)
Watching at the cab stand
The family who is hosting us return to the US for the summer today. We had a momentous final night together, as the seven-year-old lost her tooth! While the tooth fairy left five cedis (about $3.50), she forgot the tooth! Her parents hypothesize that it is because the tooth fairy wishes to give our toothless friend some American dollars too.
Matt and I ventured out in the rain to walk around the Jamestown area of Accra last weekend. Already getting a lot of looks for being white people walking around in the rain rather than riding by in the shelter of a cab, we continued to attract people and were asked for money by a “tour guide” and two “security guards” during our couple of hours there. You can read more about this on Matt’s blog. We walked around the outside of a former slave castle, heard Christian prayers being spoken over loudspeakers, saw a coast that alternated between smooth sand and layers of trash and sewage, and saw soccer games taking place in every possible location; in streets empty due to the lack of traffic on Sundays, in abandoned buildings, in small courtyards, and in nicer stretches of beach.
As we were leaving, we stood on a corner for a while deciding what to do next. I saw what I thought was a pile of belongings protected from the rain under a trash bag move, revealing instead a young woman with a baby under a trash bag to avoid the rain. I’ve wondered since then how it would have gone over if I had walked over to hand her 10 cedis, or 20 cedis, or a package of biscuits and some milk; I’ve thought that next time I should find out.
I turn 25 tomorrow and my fabulous TAMTAM coworkers surprised me with an awesome cake!
It made me think about what I was doing last year at this time. Matt and I were in Utah on our road trip around the United States, dealing with a mouse situation that is worth reading about.
More updates from Accra to come soon.
6:30 in the morning is a very happening time at the Accra market
Though it was refreshing to travel into the lush, green grasslands (turned wetlands in the rainy season) outside of Accra, I am too tired to write much about the experience because we had to get up at 5:30 to do it. We showed up an hour early for a morning meeting at a local NGO and they were typically extremely generous, proceeding to spend the rest of the day showing us around the communities in which they work. Here are photos of first a farming village and second a fishing village. Homes are set up in compounds, with an outdoor living area and multiple families having one room within the same buildings. There is usually one bed per family’s room, with four to eight people sleeping in each room; parents typically sleep on the bed and children on a thin mat on the cement or dirt floor.
We also took a tro tro (local name for ubiquitous fast vans) for the equivalent of $2 for our journey of two hours and I went to the bathroom in a hole in the ground for the first time since being here. We saw that there was a big need for mosquito nets, as most people there do not have access to them but would like to use them. I am excited that our study will take place in settings such as this.
A farming village about 2 hours outside of Accra; mud houses, electricity (sometimes)
A fishing village about 2.5 hours outside of Accra; TV antennas
Carving a large tree into a large boat