Making History

Dr. Fred Abrokwah is making history in Ghana by offering the first antiretroviral treatment to his patients affected by HIV/AIDS. See post below (Back on Their Feet) for full story.

Their Forefathers, Our Ancestors

Last January, I visited the Elmina slavery castle on the Western coast of Ghana, accompanied by a good friend of mine from home. Cape Coast, Elmina, Axim and so many other villages on the "Gold Coast" are horrible but necessary symbols of Africa's bloody past. We saw the cells where slaves where kept before heading on the boat... some walls still had marks from the slaves' finger nails--tragic attempts to escape, perhaps? Some cells where devoted to the useless slaves: death chambers where sick or rebellious slaves were condemned to suffocation. I had seen many of those sites before. Seeing it through my friends' eyes, during her first trip to Africa, was simply refreshing.

Th guest book at the Elmina castle, had several entries from African-Americans who had come to learn about their own history. One of these "pilgrims" had written:

"I connected with my Forefathers"

My friend and I couldnt help but write, just below those words:

"Disconnected with our Ancestors"

Hopeful Cynicism

Some call me cynical, others positive, some pessimistic, others idealistic. No one seems to agree. Neither can I for that matter.

I definitely became cynical after 9 months in Ghana. I'm not sure cynical is the right word. You judge.

I had to deal on a daily basis with Africans' inferiority complex. Although it was not new to me, it was first shocking, then disturbing and finally revolting. After centuries of slavery and colonialism, the average African (educated or not) uncounsciously believes that the white man is superior. Only one person, a taxi driver, said to me bluntly: "Look at all that you have in the West... You have so much more than we do. It's obvious that white people are smarter." Other Ghanaians or Africans, are much more subtle about this sentiment and are mostly not aware of it. Can I blame them for thinking that way? Not really. How can they believe that we too, in the west, have unemployed, homeless and even starving people, when what they see on TV is "Dynasty," Oprah's disgustingly lavish Christmas show "My Favorite Things" featuring Ralph Lauren's lovely cashmere sweaters, or Bush's attempt to take over the world at all costs?

The fact that the majority of "white" people in Africa are expatriates living in enclaves--some wealthy families living on UN/Diplomatic salaries or young illusioned volunteers who can afford to see the world--definitely does not help Africans' complex. First, they saw white people taking their brothers away on large ships, then they saw the great white man take over their whole land and tell them what to do, then the white man handed them back their chaotic land while still telling them what to do while giving them loans, blablabla... Yeah, we all know the story. Today, however, good intentioned NGOs (like mine) are somehow encouraging this inferiority complex. Even with the best approach possible, I felt like my African colleagues always saw me as the "white person who is here to show us how to do it." How could they think differently, no matter what I say or do, when it's what they have seen since they were born? This attitude then provokes passivity and carelessness... "Well, we're good for nothing anyways, let's get the white person to do the job and we'll get some good money in the process."

As long as my skin will be white in my workplace in Africa, as long as money will be white in Africa, I truly believe that Africans will remain in their misery. We can't help them to help themselves, as much as I would like to think so. Only Africans can pull themselves out of the hole... For that, yes, maybe they'll need to reach the rock bottom, for them to recognize that... Is it the only solution?

Despite these thoughts I remain hopeful and I won't stop doing what I'm doing. Despite the bad I'm contributing to, in the whole, maybe its worth it. Maybe I am just selfish and want to make sure that when I wake up in the morning I can have the feeling that I am "trying" to do something in this world.

Back on their Feet: How Africans are Surviving AIDS

It is estimated that 200 people become infected each day in this West African nation.
While Canada is about to become the first industrialised country to introduce legislation that will make cheaper HIV/Aids drugs available in developing countries, in Ghana, Dr Fred Abrokwah is already giving his patients a second chance.

On a hot April morning, at 8:30 am, there are 25 people waiting outside Dr Fred Abrokwah’s office in the Fever’s Unit (Aids ward) of the Korle-Bu Teaching Hospital in Accra, Ghana.
One patient sits in a wheelchair, his head tilted, mouth opened and eyes closed. He is too thin and can barely breathe. As the doctor’s door opens, a patient comes out, while three others rush forward, not waiting to be called in.

Thirty-year-old Dr Fred appears at the door, wearing a lime coloured button-down shirt, looking slightly tired. With one gentle motion he pushes the patients aside and calls in the man in the wheelchair and his two young relatives.

It is an “Opportunistic Infections” day at the Fever’s Unit, where Aids patients suffering solely from serious infections are admitted. Dr Fred is the only permanent full-time doctor in this Aids ward where more than 2,000 patients come to be treated.

His office is almost bare: blue and white kente curtains (cloth from Ghana’s powerful Ashanti kingdom) with Danida (Danish International Development Agency) printed on them, a small wooden desk with four chairs and a bed covered with a white sheet where the words "Donated by Miss Universe 2001" can be read.

Speaking in both Twi and English, Dr Fred examines the man in the wheelchair. He pinches the patient’s skin, checking for any sign of dehydration. As Dr Fred touches his stomach, the unconscious man moans quietly. The problem is clear: urinary retention probably caused by an untreated case of gonorrhea.

During the inspection, Matron Laetitia, the head nurse, comes in, standing tall and strong in her white dress. Dr Fred tells her he’s not feeling too well today, probably allergies. Looking upset and worried, she responds: “Why did you come in then? You have seven files on your desk. Hurry up and get lost!”

Dr Fred smiles shyly. For the first time, he looks towards the corner where I’m sitting quietly, and asks me: “Have you noticed there are many less people today than usual? It’s because of the ARV treatment.”

Antiretroviral (ARV) drugs slow down the reproduction of HIV in the body. Although it does not cure the disease, it helps people infected with the virus to prolong their lives drastically. Korle-Bu hospital became one of the first public hospitals in Ghana to offer cheaper ARV treatment to its HIV/Aids patients last December.

In October 2003, the Fever’s Unit counted only 20 patients who privately benefited from antiretroviral drugs. They were paying about 800,000 cedis a month (about CAN$120) for the treatment. Ghana’s average monthly income is of merely 200,000 cedis ($CAN30). Today, the costs for the treatment are of 50,000 cedis (CAN$7.50) per month. Now, less than five months after the program began, more than 400 patients are using the drugs at Korle-Bu. By the end of 2004, it is expected that 1,200 patients will be taking ARV drugs at Korle Bu, at a rate of 100 new users each month.

The drugs being used were manufactured in Thailand, one of Asia’s first countries to produce ARV medication at highly subsidised prices. This is thanks to a US$5m grant from the Global Fund; an independent organisation governed by representatives from governments, nongovernmental organisations (NGOs), the private sector and affected communities. Canadian Prime Minister Paul Martin recently promised that Canada would give CAN$70 million towards the fund, which is also backed by rock band U2’s lead singer, Bono.

Before being able to receive ARV treatment, HIV/Aids patients need to undergo a CD4 count test. CD4 count measures the level of HIV in the blood, to determine the staging and outlook of the disease. Normal CD4 counts range between 500 and 1,500. Any HIV patient with a CD4 count of below 350 should begin receiving treatment.

HIV-infected persons who have CD4 counts below 200 are regarded to have Aids, regardless of whether they are sick or well. However, CD4 count tests are still quite expensive in Ghana, at about 250,000 cedis (CAN$38) per test.

Perpetua is 35 years old and the President of the Wisdom Association, a local association of People Living With HIV/Aids (PLWHA) that has offices in the Fever’s Unit. She has had HIV/Aids for four years. When I met Perpetua last October, she looked ill and scrawny, weighting less than 45kg.

Today, she has gained more than 15kg and looks perfectly healthy thanks to Dr Fred’s ARV treatment. Perpetua says that Dr Fred is “One out of thousands. Just the way he talks to you, always asking how you are. Every patient who comes in asks to see Dr Abrokwah,” she says.
Audrey, a member of Wisdom who is also benefiting from ARV treatment, says that Dr Fred helped her a lot emotionally. “He made me know that I am not going to die, that I will get better,” she explains.

Audrey says Dr Fred has become a personal friend. She remembers one Sunday morning when she was not feeling well; “I called him at home and he came to meet me at the Unit to treat me.” Last October, Audrey’s CD4 count was just 5. Today, it is at about 120. “I’ve grown fat and my body has changed”, she says proudly.

As most PLWHA, Perpetua and Audrey still live in fear of the stigma associated to HIV/Aids. Only Peterpetua’s mother is aware that she is ill. Even now that she looks healthy, she does not want her picture taken or be associated with the disease.

When Audrey is asked how she contracted HIV, she responds it must have been through a pedicure. Most PLWHA in Ghana will deny having contracted HIV through sexual contact. Dr Fred explains that “almost everyone knows about the disease. The knowledge has not yet been transformed into behavioural change.”

According to him, basic HIV knowledge should be included in Ghana’s school curriculum. “We also need a lot more commitment from religious groups,” he says. “People listen to their pastors a lot more than they do to other people. People in Ghana are very religious.”

Dr Fred is always calm and serene and looks much younger than his 30-years. Originally from the Eastern region of Ghana, Dr Fred studied medicine at the University of Ghana at Legon, in Accra. When I ask him why he became a doctor, he remains humble.

“I wouldn’t bore you with those noble things like wanting to help people,” he says, “It’s really because of the interest I had and the support from my family, especially my mother.”
Dr Fred remembers difficult times growing up when his mother struggled to raise her four sons after her husband’s death. As a child, Dr Fred sold soap after school in the streets of his neighbourhood to help his mother make ends meet.

Following his year of internship as a medical student at Korle-Bu, Dr Fred asked to be assigned at the Fever’s Unit. “I chose the Fever’s Unit because it has been completely neglected,” he says. “Nobody was doing much about the Fever’s Unit. There was no definite treatment for the illness. It was a big challenge. And area where you could really be on your own and do something new. You had to build something from scratch.”

When the ARV treatment program finally began, work was overwhelming at the Fever’s Unit. “It was terrible.... We lost a few patients. We lost about two per cent of the people,” says Dr Fred. “The people we lost were probably people who were at too advanced a stage of infection. Half of them started with a CD4 count of 1, so we started when it was too late.”

After examining a woman in her late 60s, Dr Fred opens a big jar of antibiotics manufactured by GlaxoSmithKline, in Kirkland, Québec. Counting the orange and white pills, Dr Fred says: “This is thanks to a donation from the Kay Morris Foundation in Canada. They’re really good drugs that we are using at the unit for people who can’t afford them.”

Although Dr Fred welcomes aid from foreign countries, he condemns Africa’s negative image in the Western world.
“Some officials in the West have said that Africans don’t have a concept of time, so ARV cannot be used in Africa,” he says. “I feel so insulted when I hear such comments.”

Another of Dr Fred’s patients, Emmanuel, is in his late 50s and complains of rashes. Dr Fred asks him if he has done a CD4 count test. “No, I can’t afford it. I’m waiting for my sister to give me money. Every morning I wake up praying to God I can afford it,” Emmanuel responds, looking down at his feet through his large glasses. Dr Fred sighs calmly. “We are trying to get it cheaper”, he reassures him.

Although the ARV treatment has now been made more affordable, there are still many other drugs that Dr Fred’s patients cannot afford, as for meningitis or toxoplasmosis. “You have to give second-rate drugs because they can’t afford the correct drugs. We lose quite a few patients because they can’t buy treatment,” says Dr Fred.

“We lost some patients because they got depressed and just gave up and refused to go along with the treatment because the family support is just not there.”
After almost two years at the unit, Dr Fred still struggles every day when he faces the horrors of HIV/Aids. “I don’t know how I manage. Sometimes it’s really hard for me. I’m becoming callous now,” he says. “I see people with malaria and minor chest infections and they tell me they are suffering. I tell them they don’t know what suffering is, so please shut up... I’ve seen too much suffering... so much so, some people have become like animals.”
One particular case taught him to separate his personal feelings from his work. “One lady became a personal friend... a young lady of about 24. We lost her to cerebral toxoplasmosis. That perhaps was the case that affected me the most,” he says. “People suffer a lot before they give up. The illness really brings you down to your knees. It really humbles you.”

Still, Dr Fred is quite hopeful for the future of his patients. “At a point it will become boring for me, because the challenge will be over,” he says, “they are looking to put many people on treatment. It will not be challenging anymore, and then I will leave.” If Canadian legislators fulfil their promises, perhaps Dr Fred Abrokwah and more doctors like him in Africa will see a shift in their day-to-day work.

Paying for Africa's Online Shopping Spree

Emmanuel is a thief.

Not the kind who will come in your house in the middle of the night. Every afternoon, Emmanuel sits in a hot and stuffy internet café in Osu, a commercial neighbourhood of Ghana’s capital, Accra.

Fast food chains, banks, clothing stores and a few street bars decorate the main road of Osu.
For about one dollar an hour, Emmanuel logs on the internet where he buys computers, cellular phones, Discmans and other expensive electronics. There are rarely more than 10 people sitting in the café, where about 30 computers are stacked next to each other, in neat rows.
On his lap sits a white sheet of paper with a list of neatly written numbers. Emmanuel’s job description is simple: use stolen credit card numbers to purchase pricey items in North America that will then be sent back to him in Ghana.

When I met Emmanuel, he was surfing on a Motorola web site. While sitting next to him, working on my laptop, I suddenly asked him if he could get me one of the cell phones he was looking at.

“Well, this one is 120 dollars,” he said, looking at me suspiciously, “but I can get it for you for 50 dollars.” As I pretended to look very interested, he added: “If you give me your address in America, I can send you the cell phone for free along with other things for myself. You’ll just have to send me the other items here in Ghana.”

We giggled, shook hands and I told him I’d think about it.

According to Ohad Folman, a New York IT Consultant who has worked in Ghana, Accra has become a hub for credit card fraud because of the country’s political stability and the lack of infrastructure to prevent such crime.

“Nigerians have brought the technology to Ghana,” says Folman. “It has become too big of a phenomenon in Nigeria, where a lot of emphasis has been put on internet fraud.” There are more than 16,000 internet cafés in Ghana, which are not monitored. No one has ever been arrested for internet fraud in the country.

“People don’t look at it as a bad thing, but rather a survival thing,” says Folman, “They are not aware of the moral aspect of it….It comes from a different point of view; whatever I can do to get some stuff.”

Not surprising, considering that Ghana’s average monthly income is of 30 dollars. Typically, a defrauder will have access to accounts through internet sites which generate credit card numbers (www.darkcoding.net) or through contacts who work in hotels and large restaurants.

A few days following my encounter with Emmanuel, a young boy of about 14-years old was sitting next to me at the same internet café, chatting on an online dating service.
Looking over his shoulder, I noticed the picture on the right-side corner of the conversation box: a 30-something white woman with a shy smile and an unflattering hair cut. I couldn’t help but read their conversation:

Young Boy: You are so beautiful my darling.
Woman: Well, thank you!
Young Boy: I love you so much.
Woman: How can you love me? You’ve never met me!
Young Boy: If you give me your address, I’ll send you flowers.
Woman: Really? You will?

In less than a minute, the young boy had been able to get a safe address in North America where to send internet purchases made with stolen credit card numbers. Folman says this practice is common.

“They will make connections with innocent women on AmericanSingles and make them feel good about themselves,” he says. “They use an emotional aspect to get women to agree to send them the illegal purchases back to Ghana.”

There is no monitoring done at Ghana’s borders, which makes the process easier. “I know of someone who ordered a sound system and was able to bring it back into Ghana,” says Folman.
Most internet café managers are very aware of the trend. “They don’t care…. These [criminals] are really good for their business,” explains Folman. “They are regular customers.”

Last January, the FBI tried to prevent purchases online at Busy Internet, Ghana’s largest and most modern internet café, by forcing the management to ban access to secure websites. Busy Internet now has private monitored booths available to customers who wish to access their bank accounts or make purchases online.

During my last week in Ghana, I stayed at the Blue Royal, a mid-range hotel in the same thriving area of Osu. When check-out came around, I had no cash and had to pay with my visa card. I knew the risks, but all the staff there had been so kind and trustworthy.
A few days after my return from West Africa, I got a phone call from the fraud department at my bank. The agent asked me if I had made purchases at Dell Computers, Tower Records and Peopledata.com.

I smiled, imagining Emmanuel sitting behind a computer, my credit card number in his hands.

Striving on Human Misery?

I was writing a grant proposal today for a project on ethnic conflict in Northern Ghana. This conflict is quite isolated and definitely overlooked by many Ghanaians and of course, the international community. Accra, Ghana's capital, is more than 14 hours away by car from Tamale, capital of the Northern Region. It's a dry and poor area. Ethnic clashing has been occurring for more about 10 years. The region has been declared a state of emergency for the past two years.
So, I'm researching for my proposal and I suddenly found out that Ghana's president, John Kufuor, has just lifted the state of emergency in the North of the country, since the area has been quite peaceful in the past few weeks. As any human being, I should be relieved, right? Well, this was my immediate reaction: "Bummer"
Yes, sadly enough, I'm coming to realize that NGOs are striving on human misery, wars, conflicts and any bloody event that can occur... Oh, of course, there are plenty of those nowadays. Enough work for all of us. Isint it somehow sickening though that I was disappointed about the lifting of the state of emergency, because now it will be more difficult for me to justify my project in the eyes of grantmakers? Thus, more diffcult for me to raise money for the programs I run in Ghana?
Even a Ghanaian friend of mine, Akwasi, mentioned that it was difficult for Ghana to get international aid these days. "We're too peaceful," he said.
Sad, very sad.

Catch Me if You Can

Being A Wannabe

Starting up my own NGO is full of frustrations and discoveries. Yesterday I was a graphic designer, the day before a receptionist. Today, I'm trying to be a documentary producer. Oh the challenges of pretending that you actually know what you are doing and how you are going to go about it!
If anyone is interested in financing a thought-provoking, groundbreaking documentary on mining and human rights in Ghana, please let me know.

If I convince people that I can actually make a documentary, even though I've never touched a camera, maybe I will convince myself and will then be able to do it. That's how my NGO started. I had an idea, I wanted to do it, and somehow, I managed to do it. Looking back, I'm not sure how it all happened, but we now have an office, 8 volunteers on the ground and more than 5 employees. It is the ultimate proof that if you blindly believe in something you can convince others and yourself, and become whatever you want. I guess you would call that a legal fraud?

Or is this just a remake of "Catch Me if You Can"?

Africa, the weakest link

Larabanga, Northern Ghana

Fever's Unit (AIDS ward), Korle-Bu Hospital, Accra, Ghana
Under a large mango tree, behind the Unit, members of the Wisdom Association (a group of people living with HIV/AIDS) weave "red ribbon" pins that they then sell to whomever they can for less than $1.