International Reputations

A Ghanaian commercial on TV for a printing company ended with: “American Quality, Chinese Prices.”

Whenever the medical students want to go out dancing, they never forget to include the foreigners staying in the dorms. However, I’ve only seen one female Ghanaian medical student go out with us. It’s almost always the foreigners plus Ghanaian guys. Why is that?

At the district hospitals I’ve visited, a handful of staff will pointedly ask if I’ve brought anything from the US with me for the hospital. They say that since I am from the US I am very rich. Little do they know that I’m leaching $60K a year just for med school and will probably never see real money until I’m at least 40!

A UK soccer commentator says that one of the reasons why the US lost to Ghana on Saturday was because the US was overconfident and arrogant…as usual. Apparently President Bill Clinton said that the US would win the World Cup…

For better or for worse, I’ve shocked the Ghanaian medical students that I can hold my own on the dance floor in clubs. When did being Asian mean not being able to dance? I think they need to spend some more time on Youtube watching AADT :)

I realize that stereotypes are out there, but how does this affect international relations? What do y’all make of these reputations?

Cooking in Ghana

I’ve been staying in a guest room attached to the hospital administrator’s house at St. Martin’s Hospital in Agroyesum for the past two weeks. Everyone in the hospital has been extremely gracious and accommodating from helping out with my research to letting me observe in the hospital to trying to cook American food for dinner for me. Besides inundating them with Michigan gear, I wanted to do something more personal for everyone, so I thought I’d cook…something Chinese or American.

However, this is a lot easier said than done. Obstacles I need to navigate:

• Daily irregular power outages
  
• Vegetables available: lettuce, green peppers, green onions, onions
  
• Meat available: chicken and maybe goat
  
• Seafood available: canned mackerel
  
• Carbs available: rice, bread, spaghetti, yams, plantains
  
• Spices available: salt, cayenne pepper
  
• Other proteins: peanut butter, beans, eggs
  
• No cheese
  
• Unclear on the pots and pans available
  
• My own limited cooking repertoire

The unavailability of pork or even better ground pork eliminates a lot of Chinese dishes that would have been fun to demonstrate like wontons and dumplings. I didn’t want to make fried rice because they have that and I didn’t want to make a noodle dish like lomein because that again is too similar to what they already eat. I could do Chinese cold noodles, but I’m not sure if peanut butter sauce would be a hit. No cheese means no Italian. After much thought and remembering that Opoku Trading Center, an “Abrofo Market” (White Man’s Market) in Kumasi, carried cake mix, I decided to bake cupcakes. For those cupcake masters reading this, yes, I’ll be making them with a mix rather than from scratch…don’t judge! The typical Ghanaian meal never seems to include sweets or dessert, so this will hopefully be unique enough.

This past weekend, I went to Kumasi and bought cupcake pans and cake mix. Maybe muffins will be a better description since frosting may be hard to pull off…we’ll see what I can do. Wish me luck! I really hope this won’t turn into a disaster! Pictures to come soon.

What Chinese/American dish would you have suggested to best showcase a different cuisine?

Lights Off and Let the Sweating Commence

I haven’t yet determined the reason why this happens, but almost every day for at least 10 minutes and sometimes long hours at a time, the electricity will shut off. This can happen anywhere: big cities like Kumasi and small rural areas like Agroyesum.

I’ve seen the power disappear in the middle of surgery, in the middle of watching soccer games, in the middle of dinner, and in the middle of the night. If someone is actually turning the power off, it’s unpredictable, except that the power has never shut off in the middle of a Ghana soccer match. The hospitals have generators to prevent mass chaos and casualties from ensuing.

In Ghana, the power outages are called “lights off.” We met an engineer once at the Catering Rest House who said he was working with Ghana’s electricity provider and his project was to design ways to increase Ghana’s effective use of energy. Apparently Ghana loses about 30% of its energy while the international standard is 18%. Perhaps this is part of the reason for so many lights off incidents.

Since my computer thankfully has a very long battery life, the biggest inconvenience of “lights off” is that the fans shut off and stop their relieving spinning. Even though I was raised in this weather and have spent summers in equally hot and humid places like Taiwan, Shanghai, and Hong Kong, I still sweat like a smelly boy in this weather. Michigan and Boston can also get pretty horrible over the summer. I don’t even have to do anything to sweat. I can sit and sweat and without the fan, I will sweat while I’m sleeping here. It’s disgusting. So, “lights off” is very bad news for me. If I had the same disposition as the Ghanaians and didn’t sweat in 85+ degree weather, then lights off wouldn’t be so unbearably uncomfortable. Are portable handheld generators available? Lydia, could you make me one?

Do You Speak China?

Despite China being heavily involved in a ton of infrastructural investments all around the continent of Africa, seeing someone with an East Asian background is a very rare occasion. On top of that, whenever I introduce myself to a Ghanaian, they are surprised that I have the “Christian” name (Eva) and have an American accent. Perhaps it’s too vain to think this way, but whenever this happens, I’m not offended. Instead, I feel almost proud that I’m bringing what it means to be an American Born Chinese (ABC) to Ghana.

I was prepared to explain my appearance to Ghanaians, but I thought my Chinese background would end there. Who knew that I’d be asked to use my Chinese while I’m in Ghana!

During an early car ride back to Kumasi in the new truck of one of the St. Martin’s hospital employees, one of the passengers found a first aid kit in the glove compartment. The first aid kit must have been manufactured in China, because there was Chinese on the packaging of all of the kit contents. The majority of the contents were easily identified despite the foreign packaging: Band-Aids, surgical tape, cotton balls, gauze, etc. But, there were two medications in the kit that were less straightforward. After examining the two boxes for a long time, the passenger turns to me and asks, “Do you read China?” I’m immediately startled from my dozing by his question and try to clear my head as I stare at the Chinese characters on the instructions of the two drugs. I recognized all of the characters for the first one: an analgesic cream, but the second one was much harder to figure out since it has been at least two years since my last Chinese class and I’m not the best at reading simplified Chinese. I think the second one was a blood clotting drug to stop bleeding.

As we drove down the bumpy road towards Kumasi, I hoped not only that we wouldn’t get into a car accident, but also that no injuries in the potential car accident would result in massive bleeding! I definitely didn’t trust my Chinese enough to rely on that drug to save lives.

Mango Season is Over!

I have been in Ghana for exactly three weeks and have still only eaten about 5 mangoes. Why is this number not 21? One for every day I’ve been in Ghana like I had hoped it would be? As I sadly found out from the Ghanaian medical students, mango season is over!!!!

In Ghana, mango season is usually from January to about May. That is why I rarely see any on the street and the ones that I buy are less than spectacular. Argh…! This has got to be my biggest disappointment in Ghana, especially since mango season just started at home in Florida. This is an even greater disappointment than inconsistent electricity, running water, mosquitoes, and inefficient work streams.

Anyone want to send me some mangoes?

Perhaps I’m Destined to be a Surgeon: C-Sections, Hernias, and Buruli Ulcers, Oh My!

I think I’m in the minority in that I am a med school student and I have no idea what I want to specialize in. I’m under the impression that all of my classmates know that neurosurgery, cardiology, infectious diseases, pediatrics, or urology is their calling and I still can’t even make the decision between medicine and surgery. However, my time here at Agroyesum in St Martin’s Hospital may change that.

In addition to my research work, the physicians and staff at St. Martin’s have been kind enough to let me shadow and observe their work. I have been in the maternity wards to watch deliveries, and in the pediatrics ward to see the buruli ulcers on children. But, without a doubt, my favorite place to be in St. Martin’s hospital is the operating theater.

It could be because that this is the only area of the hospital with air conditioning, or the only place I feel clean, or that surgery is the only area of medicine that I feel confident enough be able to follow the entire procedure (yeah for anatomy!). In just three days, I shadowed three different attendings and got to see a caesarean section, a breast biopsy, the repair and suturing of a severe mouth wound, an inguinal hernia repair, an incisional hernia repair, an abscess debridement, and four skin grafts to repair buruli ulcers. The technical precision and clinical creativity of each procedure, no matter how routine, absolutely fascinated me.

Even though there is a standard best practice for surgical procedures from administration of anesthesia all the way through to the close of the surgery, each body seems to contain within it a different collection of details as if carefully selected by a curator with a keen eye. This degree of human variation affects all of those standard best practices. How quickly will each individual metabolize the anesthesia? How much subcutaneous fat does each individual have? How much blood will the individual lose throughout the surgery? What kind of sutures would promote healing and minimal scaring? These are all considerations and decisions that surgeons must calmly, quietly, and efficiently make while standing with an individual’s health and life in their hands. Isn’t that awesome?

There is just enough uncertainty within the certainty of surgery to keep things interesting. And the best part is that at the end of the procedure, after you have finished closing, you have the satisfaction of contributing to the health of the individual’s life with your own hands.

What would totally convince me is if I was asked to assist by holding onto a retractor or even helping with cutting through the subcutaneous fat. How could you sit in an office all day when you have this excitement happening in the operating room?

Ghana Black Stars

If my time in Ghana teaches me nothing about maternal mortality, I will at least have left with a better understanding and much greater appreciation for soccer/football. Thank you Bryant for the best quick soccer synopsis (posted as a comment). I've officially caught World Cup Fever and can't wait to join all of Ghana tomorrow to cheer them on in game 2 against Australia.



So, what's it like watching the World Cup in Ghana? From my research project's perspective, the World Cup is a significant enough distraction that I have to plan my assessment and interviews around it. There are usually three games a day and the first game starts at 11:30AM, so I have to try to talk to the right people before 11:30AM. Or I'll have to compete with the buzzing sound of the vuvuzelas. My interviewees' eyes will literally drift towards the TV while I'm talking to them!



Though if Ghana is playing...the entire country is sitting in front of a TV. Erika and I made the mistake of trying to visit the National Cultural Center during the Ghana game last Saturday. It was "open" but all of the employees were occupied watching the game. Even the streets were deserted! We will not make that mistake this week. At 2PM tomorrow, we will sit in the medical school lounge and watch the Ghana game. Now, we just need to run out and get some Ghana Black Stars flare!

US Team Update: We tied with Slovenia...even though we should have won! That last ref call was totally wrong! He should walk home with a bodyguard tonight...

Engrish

One of the things I love to see while traveling is the availability of different types of goods and products and how they are marketed. For example:

• In China, KFC is HUGE and almost as popular and ubiquitous as McDonalds in the US.
  
• MOS Burger is a Japanese burger chain that has a burger that replaces the standard hamburger bun with toasted rice patties that look like bread
  
• Anything and everything uses sexy ladies in bathing suits in their advertisements in Peru from alcohol (expected) to printing/copying companies to public health notices (totally unexpected!)

On top of all of that, Engrish or spelling and grammar mistakes always provide a good laugh. Here are a few Ghanaian examples: Want to attend pre-university? DEBEST is clearly the best option. An energy drink sponsored by MTV's Staying Alive Foundation. Perhaps its placement near the Aphrodite drink is appropriate? Very unfortunate name for a milkshake type drink.

I think the beverage industry could most certainly use some marketing help!

Anyone else have funny examples to share?

Kitty would have survived in Ghana...

The bystander effect is a curious social phenomenon that is commonly illustrated by the murder of Kitty Genovese in Queens, New York. The story goes that Kitty was being attacked and stabbed to death in front of her apartment complex and all of the residents just stood and watched. No one came to her rescue and no one called for help. This social phenomenon is believed to occur when responsibility is diffused through a large group. Every single individual assumes that he or she is not directly responsible to act because someone else in the group will take action, leading to collective inaction. SuperFreakonomics discusses the validity of the Kitty story to illustrate the bystander effect. But, I’ll ignore this controversy for the purposes of this post.

Yesterday, I witnessed a remarkable event that proves that if Kitty was attacked in Ghana, she would have survived. On my drive to Agroyseum, we saw a construction truck flipped over off the side of the road. We slowed down just like the drivers around us demonstrating rubbernecking. But, we were not just slowing down, we were stopping. All of the cars around us were also stopping--buses, taxis, personal cars, other construction vehicles, and tro-tros (large vans transporting people) all pulled over. At first, I thought everyone was pulling over to get a better look at the accident. But, people were not just looking. In seconds, a crowd of men gathered around the truck and were pushing it to free the trapped driver underneath. After pulling the driver out from under the truck, they stopped an incoming taxi and carried the injured truck driver into the taxi with specific orders to the hospital. Once the situation looked like it was under control, we climbed back into our car and were back on the road.

If I was driving alone, what would I have done? I’d slow down to take a peak. I would not stop. I wouldn’t even dial 911. I would just continue driving and assume that someone had already alerted the appropriate authorities and that help was on the way. I don’t have my MD yet, so I can’t possibly be of any help. The Ghanaians have made me feel like a horrible person. This sense of responsibility to all humanity is something we could and should learn from the Ghanaians.

Are you single? You Can Be My Wife.

In college, if I was craving for a burrito, my favorite place to go was Felipe's. The burritos are good, the speed that the burritos are made with quick spatula dollops of salsa and guacamole was amusing, and the servers would always give me compliments in Spanish (“What would you like, mi amor?”). Who wouldn’t love being flattered occasionally?

Growing up in a relatively large Hispanic community in South Florida, frequent visits to Felipe's, and my spring break trip to Peru have led me to believe no group of people could be more forward than the Hispanics. I am absolutely wrong. The Ghanaians have reached a completely new level.



As my fellow Obruni/bruni (which actually means white not foreigner in Twi) Erika and I have roamed the streets in Kumasi, we have made several new “friends”. Most of them are street hawkers selling paintings and other goods, but cab drivers, fellow diners, and people that we pass on the streets are included in the mix. They all want to know our names and tell us that we are special and that this connection we have established with them here in Ghana is everlasting and unique. Every encounter will end with a request for our number and sometimes address. And many of them will ask if we are single or are if we are still looking. If we answer “yes,” then they get very excited and rather than attempt to woo us, will forthrightly tell us that we could be their wife. Laughing the suggestion off is not enough because if we ever see these people again, they remember our names!

While this is very flattering, I think I prefer the cat-calls of “linda”, “guapa”, and “bonita” to these insistent marriage proposals!

Internet

I do not have an iPhone or any other smart phone. But I am the exact type of person who either should (because I’m online all the time and an iPhone would simplify my dependence on the internet) or should not have an iPhone (because I’ll be so addicted to it and become one of those people who can’t function without their phone). At home in the US, I’ve managed just fine having friends with iPhones. But here in Ghana, I don’t even have that! So, you can just imagine how hard it has been for me to be without a reliable source of internet. I don’t know what’s going on in the world anymore because I don’t have the New York Times, Google Reader or Google Buzz at my finger tips anymore. I am not glued to Facebook as I look through albums of pictures at a time. I am not watching tons of dance videos, especially Kyle Hanagami’s choreography, on Youtube. My usual less than 24 hr email turnaround time has been extended indefinitely. I still have not seen the Glee finale and have no idea what’s going on with the NBA finals. Who’s winning-- the Celtics or Lakers? What game are we on?

Coming to terms with being disconnected has been tough and trying to overcome it has been even harder. A graphical representation of my internet happiness looks like a boring rollercoaster—great anticipation only to be disappointed by several bumps.



So to everyone who might be waiting for an e-mail response from me, I’m so sorry!

Have I become a more effective and efficient person since I don’t have the internet to distract me from life? It’s hard to tell… If it weren’t for the excitement of the World Cup and being able to watch the games, what would I do with my free time!?!?

Agroyesum: A Cutting for Stone Experience

Number of mangos consumed: 3

Number of mosquito bites: 1

I left Kumasi on Wednesday (June 16) to officially start my project in Agroyesum. I will be based out of Agroyesum for the next three weeks conducting facility assessments and interviewing physicians and administrators at St. Martin’s Hospital (Agroyeseum), St. Michael’s Hospital (Jachie-Pramso), and Bekwai Government Hospital. My research will specifically focus on the changes that have occurred since the arrival of permanent obstetricians at these district hospitals and compare these clinical and management practices as well as maternal mortality outcomes with district hospitals who have not yet received permanent obstetricians. I will also be designing a complications register to implement at Agroyesum and hopefully the 7 other sites I will be visiting this summer to help the Ghana Health Services collect data on the number and types of complications these hospitals see on a day to day basis. This complications register will help hospital staff and the Ghana Health Services strategically target areas for improvement in the quality of clinical care and clinical management of these obstetrical complications.

Agroyesum is about a 1.5 hour drive south of Kumasi. It takes about 45 minutes on nice paved roads, and then another very bumpy 45 minutes on rugged clay dirt roads to get to the district hospital. Stay tuned for videos! I really don’t know how the tro-tros (bus/minivans) make it out here. These road are also not lit, so if there is an emergency after 6PM, I don’t know how drivers can navigate these roads! Questions that I need to answer by the end of my assessment! I think Agroyesum is located at a higher altitude or perhaps just being far removed from the city and in the trees makes it feel a little cooler than Kumasi. The drive to Agroyesum, though bumpy, was breathtaking. It is so lush and green. The best analogy and probably embarrassingly most inaccurate analogy I can think of is the scenes from the movie “Mighty Joe Young”-- the movie with Charlize Theron and this huge gorilla. Just think of that, and that’s where I am!



Before moving out to Agroyesum, I was lucky enough to do a quick day visit last Friday (June 12) to get familiar with the facility and meet the entire staff. As I entered through the hospital gates, I felt like I was stepping into the book Cutting for Stone by Dr. Abraham Verghese. Cutting for Stone is a rich fictional narrative that follows the lives of Siamese twins, Marion and Shiva, set in Mission Hospital, a district hospital in Addis Ababa, Ethiopia. Like Mission Hospital, St. Martin’s Hospital is a Catholic hospital and the staff are managed by a Matron. The Matron at St. Martin’s hospital is Sister Helen. She is authoritative, maternal, and sweet. I feel so well taken care of when I am with Matron.

The hospital provides several different types of services and is much larger than I had expected. There are outpatient services with three consulting rooms, female and male wards, labor and delivery wards, two operating theaters, a pediatrics ward, physical therapy, lab facilities, x-ray facilities, a pharmacy, nutrition services, and they are expanding to create an emergency medicine ward. As Matron and I walked around the hospital, I couldn’t help but think about the characters in Cutting for Stone (I highly recommend the book and am thinking of sending St. Martin’s Hospital a copy). When Matron asked me what I thought of the hospital, I kept saying, “This was wonderful!” She just laughed at my enthusiasm. I then explained to her that I was a preclinical medical student, so just being in a hospital is a novel experience. She then promised that I’d be able to see all sorts of different cases that I could learn much from. I am so glad I packed some scrubs with me!!!



To tickle my imagination even more, I am staying at St. Martin’s Hospitals as a guest of the hospital administrator, who has the most adorable twin sons (picture pending). It’s like I’m guest at Ghosh and Hema’s house! The room I am staying in is very nice and has everything I could have asked for. I have a bed, a sink, my own bathroom with a flushing toilet and shower (cold water only), a ceiling fan, and plenty of room to spread my stuff out. The windows don’t seem to be completely reliable in keeping mosquitoes out, so I set up my mosquito net. After taking my cold shower, I kept seeing tiny bugs flying towards me, so I have taken refuge in my bed under my mosquito net. I look absolutely ridiculous, but at least I feel more at ease while sitting with my bare legs exposed. I’m sure my courage to sit outside of my mosquito net will build as the days go by.

Wish me luck with my continued goal of not getting devoured by mosquitoes and my first day of real work tomorrow!

Ghanaian Food Update

It's a rule of mine while traveling to try my best to immerse myself in the local food as much as possible and avoid all and any food I can find in the US. I'm off to a pretty good start. I have managed to eat only local Ghanaian foods. Here's a quick description of things I've tried. Thank you to Roshan for giving me a quick Ghanaian food overview before leaving!

Note: If you are on a no carb diet and love vegetables, the Ghanaian diet may be a little difficult to handle...

Chicken and Fried Rice (not sure if this is truly Ghanaian)


The fried rice is similar to Chinese fried rice just minus the soy sauce. The fried chicken is seasoned in what I think is red pepper. Great easy meal to start with in Ghana. Cost: 3.5 Cedi (1 Cedi ~ 0.75 US cents)

Waakye, Gari, Spaghetti, Fried Chicken



Waakye is rice and beans similar to rice and beans dishes found in Central and South America, but much heavier on the beans. Gari is fried and ground cassava. Spaghetti is simply noodles with no sauce though usually served plain with waakye and gari. The fried chicken was again seasoned with red pepper, so slightly spicy. Cost: 4-7 Cedi

Fried Plantains, Fried Chicken, Stew




If you've never had fried plantians, you don't know what you are missing! The Ghanaian version of fried plantains is a little different than the type that you'd find in Central and South America. It is a little frier and definitely not as sweet. Fried plantains are my favorite Ghanaian food that I've stumbled upon, so far. I've asked for just fried plantains as a meal. I don't know if the stew has a more official/descriptive name. It tasted like chilli and had beans and onions in it. It was very spicy, probably due to the red pepper that they use to season the fried chicken. Cost: 4-8 Cedi

Palava Sauce


Palava sauce is some kind of vegetable mixed with some red pepper and fish and made into a sauce. Sauce may not be the best description since it is not a pure of these ingredients and not really these ingredients sitting in a broth. Maybe stew is a better term. It is kind of like Indian food dishes and is used similarly. Palava sauce can be served on top of a bed of rice or eaten with Ampesi (steamed plantains or yams). The sauce is a little spicy and the vegetables add a nice refreshing taste to it. Roshan, THANK YOU for this recommendation. Cost: 2-8 Cedi

Here is a great website with probably more accurate descriptons of Ghanaian food.

More food soon!

Ghana Time

Project Mango: COMPLETE! I have located a street market about 5 minutes from where I’m staying selling lots of fresh fruit and avocados!

Number of mosquito bites= 1

I spent a year working at the Institute for Healthcare Improvement (IHI) in between graduation and starting med school. It is no overstatement to say that my experience at IHI has uniquely transformed my trajectory in the field of medicine. But that’s not all. Some general skills that I learned at IHI are common among any formal work experience: punctuality, facilitating meetings, setting deadlines and working within them, and being extremely detail oriented in order to deliver high quality work that represents you and your team well. These highlighted general work skills really fall in line with my naturally type A personality. Everything at work is sequential, logical and orderly. I love it! As I’ve come to realize in launching my project this summer in Ghana, the rest of the world does not necessarily operate in the same way.

Global health work can be a little tricky. Developing countries have their own unique set of challenges…challenges that we outsiders are not accustomed to. However, given the tenuous relationship between developed and developing countries in history (colonization, imperialism, etc.), it is important for outsiders, including lowly students like me doing research here, to be respectful of the people and culture of developing countries. As an outsider, our role is to be facilitators and no more than that. We cannot impose ourselves or our ideas on others. We surely don’t enjoy it when another country tells us what to do. And as health care reform has illustrated, we Americans can’t even take it when the ideas are homegrown! In order to maximize the potential for realization and sustainability of the solutions generated to combat the challenges that developing countries face, these solutions must be local and ownership must be in the hands of the developing country. Just look how successful Jerry Sternin was in Vietnam in battling malnutrition in children (articles here and here).



Understanding this, the first step I’ve taken to working in Ghana and being respectful of those around me is adapting to the work culture here. I’ll be the first to admit that, this has not always been easy. One thing that has been particularly difficult for me to adjust to is starting each day with a very fuzzy agenda or even idea of what is going to happen. I’ve had to become a strong advocate for my work as I shuttle from one meeting to the next—meetings that run on Ghana time (almost never start on time). I’ve also become the central processor of my work as I synthesize what was decided during meeting 1, meeting 2, and meeting 10, internally negotiate the conflicts between the decisions, and gently introduce the new resolution to my colleagues and supervisors. Things moved at lightning speed when I was working and trying to function at a different pace has left me sometimes feeling like a fish out of water splashing around making an inconvenient mess for the people and country that already have their hands full.

Could I have done more pre-work before arriving in Ghana to have avoided this? I don’t think so. The synergistic energy of an in-person meeting complete with handshakes and smiles are irreplaceable. And when the pieces do organically fall into place, it’s magical and exciting.

My dad says this is good for me. I need to learn how to work on Ghana time because I’m apparently too high strung and hyper to begin with!

Special Report Relating to the World Cup from Kofi Annan and Didier Drogba

This newsflash from the Daily Graphic (Ghana's biggest selling newspaper since 1950) is yet another reason why I should be following the World Cup!



Kofi Annan, former UN Secretary-General and Chair of the Africa Progress Panel, and Didier Drogba, the UN Development Programme Goodwill Ambassador and soccer star published a report today (Thursday, June 10th) titled, "Scoring for Africa--An Alternative Guide to the World Cup."

The report is a novel way to draw attention to a country based comparison of key indicators of development including access to education, gender equality, economic growth, human development, and CO2 emissions. So, how is the World Cup related to this report? The report is written in the form of the World Cup schedule of matches. For example, the first country comparison is between South Africa and Mexico (game scheduled to play on June 11th). Rather than compare their offense or defense strengths, you will see comparisons in life expectancy, corruption perception rank, environmental performance rank, etc.

Some highlighted comparisons include (from press release):

• The average life expectancy in Nigeria is 48 years, compared to 75 years in Argentina.
  
• Women in Côte d’Ivoire are eight times more likely to die as a result of child birth than their Brazilian counterparts.
  
• Japan has donated $93.6 billion in ODA whilst Cameroon has received $5.2 net ODA.
  
• In South Africa 44.5% of parliamentarians (in the lower or single house) are women, compared to 18.9% in France.
  
• Algeria is contributing only 0.32% to the world’s yearly CO2 emissions, while the US contributes nearly 16%, making it the world’s second largest carbon emitter after China.

In the foreword of the report, Kofi Annan and Drogba say, “We passionately believe that fair play should not be limited to the way countries play, run, and score against each other, but also the way they do business and politics with each other; that the spirit of the World Cup should extend into countries’ economies and political relations; and that the celebration ofour common humanity should not be limited to one month every four years.”

What do y'all think of the report? Will the World Cup in South Africa bring developmental progress to the entire continent of Africa? Will this month of soccer fervor be more than just a sports competition? What kinds of changes can happen with this spotlight on Africa?

Akwaaba

Akwaaba = Welcome

Travel Time:

2.5 hrs Detroit to Atlanta 11 hrs Atlanta to Accra Overnight stay in Accra 45 mins Accra to Kumasi

Number of anxious calls from parents in 3 days: 6

Number of mosquito bites: 0

I'm finally here in Ghana! My first few days have been filled with traveling and meetings to tie up the loose ends of my project to get it going. I've been so busy that I don't think I fully realize that I'm in Africa...Ghana...on the other side fo the Atlantic Ocean...!



Using this graph of the "Stages of Cultural Adjustment" I think I'm suspended between Stage 1 and 2: Honeymoon and Conflict/Culture Shock. Why haven't I experienced cultural shock yet? I think there have been too many signs and symbols of home here:

1) I see this banner with a "y'all" on it as soon as I exit customs. 2) The weather is a nice humid heat: just standing outside will make you sweat 3) There are mosquitos everywhere and m new perfume of choice is "OFF" 4) Ghana is covered with familiar mango and papaya trees and there are lizards scurrying around all the time. 5) Rice makse up at least 50% of almost every meal

A few things that remind me I'm in Ghana:

1) I am very clearly a foreigner (Obruni in Twi). I have never traveled to a palce where it has been so difficult to blend in! No degree of a tan will ever get me close to fitting in. 2) I feel so disconnected from the world: no stable internet means no e-mail, no Google Reader, no Google Buzz! Must get this resolved ASAP! 3) Everything seems to be unnecessarily complicated. For example, if the food item is listed on the menu, it's not guaranteed to be available. 4) Shower water pressure is variable. Sometimes it's perfect. Other times, it's a trickle. And as I learned last night, the electricity could also temporarily just disappear. 5) Even though the people speak English here, I have a difficult time understanding the beautifully accented Ghanaian English. It's very different from South African English, British English, and Singlish. The best way I can describe it now is that it sounds like a mix between Jamaican English and Indian English.

I'm just waiting to dip down into the "shock" phase of cultural adjustment. But with running water, flush toilets, and air conditioning in many places, maybe I'll skip it completely!

It's so great to be here! So for now, mah krow (goodbye in Twi)!

Where are the mangos?

It is mango season in Florida. And according to every friend I've talked to about a summer in Ghana, it's supposed to be mango season in Ghana as well. So, where are the mangos?

I've walked up and down some streets and see a ton of mango and papaya trees...but no fruit! I brought a Swiss army knife with me for the sole purpose of cutting mangos. At this point, I feel like it was a smart idea to bring this bag of dried mangos, since this is all I've been able to eat!

Need a Crash Course in The World Cup

I was never a successful soccer athlete since I have difficulties in resisting the urge to touch the ball with my hands, but I completely acknowledge that soccer/football is an amazing sport! I don't understand how such a fast paced and energetic sport could be second to a sport like American football. But, because I don't actively seek soccer exposure, I'm a little in the dark when it comes to the World Cup. Here's what I know (courtesy of the SuperSports TV Channel in Ghana that is playing World Cup news 24/7):

• It's like the NBA finals of soccer, but so much bigger because it's international. So, perhaps more like the Olympics just for soccer
  
• You have to qualify to play in the World Cup
  
• World Cup 2010 is hosted by South Africa and this is a HUGE deal for Africa
  
• Ghana's team is called the Ghana Black Stars
  
• Ghana Black Stars were the first African team to ever qualify to play in the World Cup
  
• Brazil is kind of a powerhouse when it comes to soccer and I think they've won the most titles
  
• The US has a lackluster soccer history
  
• David Beckham is not playing for the US
  
• Eyes are on Spain this year...why?
  
• And I know that this is an AWESOME World Cup "trailer" made by Nike

So, how does the World Cup work? Do you play teams within your region and then progress to different levels from there? If you lose a game, are you out? Or is it best of X number of games? How are the teams to watch? Brazil? Italy? Spain? England? South Africa?

I thought I could make a trip down to South Africa to get in all of the excitement, but South Africa is actually way too far away from Ghana. The World Cup starts in just a few days! So, if y'all follow soccer at all...please help!

Wo kƆ he?

Wo kƆ he? = Where are you going?

To celebrate my last summer, I am going to Ghana! It'd be a shame to let Emily's ingenious blog title go to waste, so here it is: "Eva Ghana Wild."

I fly out in just two days to spend my summer doing clinical quality and management research on maternal mortality at six district hospitals in and around Kumasi. With cans of bug spray packed, I think I'm ready! This is my first trip to Ghana and my first time venturing out to Africa, so stay tuned for pictures, impressions, and hopefully not too many vignettes about embarrassing myself!

Psst...if you are in Ghana this summer, let me know!