ACCRA, Ghana to LOME, Togo – Today I traveled 200 kilometers and 24 years, from the booming capital of Ghana with its pothole-free roads and growing economy to the decaying capital of Togo, where I was a Peace Corps volunteer from 1983 to 1985, a place and time that holds an affectionate place in my memories.
During the four hours I was on the road, I experienced a jumble of emotions – hope, fear, nostalgia and sadness.
Hope was what I experienced in Ghana, a country whose economy is growing and which recently experienced a peaceful transfer of power from one party to another, despite a close election, something of a rarity in Africa. This is the hope that brought President Obama here in July on his first presidential visit to Africa. We drove out of Accra on a motorway – the likes of which I have seen in Africa only in Abuja, Nigeria and South Africa – and past a blur of gleaming buildings and a new shopping center. It gave me hope that positive change is possible in West Africa.
The fear came from our driver who, like me, had a Biblical name (Isaac) and succeeded in putting the fear of God in me. He tried to keep the speedometer at 140 kilometers per hour (85 mph) as often as possible, including through villages with a posted speed limit of 50 kph. I said a silent prayer for myself, my Togolese companions and any careless pedestrians who wandered into the road.
It was evident that the driver knew the road extremely well as he braked only for speed bumps and police stops (all the police stops had signs sponsored by a bank that warned “It is an offense to bribe a police officer,” something else that gave me hope). And he knew exactly where to brake. As Isaac was slowing in one village, someone along the road yelled at him and Isaac threw a one-cedi note out the window, perhaps repaying an old debt.
I was astounded by the quality of the Ghanaian roads for the first 170 kilometers. I have never seen such excellent roads outside of an African city except in South Africa. It was only because of the quality of these roads that we were able to maintain such high speeds.
But the closer we got to the Togolese border, the worse the roads got and the more the scenery reminded me of the coastal village in Togo where I spent two years. The last few kilometers to Aflao, the last town in Ghana before the border, were terrible, deteriorating from pothole-pocked roads to no pavement at all.
The nostalgia came as the scenery became prettier and prettier, reminding me so much of the Togolese village of Baguida that I will see tomorrow. I also felt gratitude that I had the good fortune to live in such a charming seaside village for two years.
The sadness came when I arrived in Lome and saw that while Ghana has flourished, Togo has deteriorated. More on that in my next post.
Saturday, October 3, 2009
Ghanaian AIDS orphans touch our hearts
ACCRA, Ghana — My heart and those of the members of the International AIDS Candlelight Memorial Advisory Board were moved Wednesday when we visited the AIDS orphans and the HIV-positive adults cared for by the Pathfinders Outreach Ministry, a Ghanaian non-governmental organization working and struggling with minimum resources in a poor area on the outskirts of Accra: http://www.pom-ghana.org
As the adorable toddlers scampered into their arms and our laps, we heard Becklyn Ulzen-Christian, Pathfinders executive director, describe the care she and her staff provide for orphans and vulnerable children and HIV-positive adults in the face of limited resources, great stigma against HIV-positive people and other challenges.
Pathfinders looks after 70 children, 13 of whom lives at the facility, and many HIV-positive adults who have been rejected by their families and friends. We talked to Felicia, a middle-aged woman whose hard life is etched on her face, who has been HIV-positive for 17 years. She said she has found a new life in the warmth of Pathfinders and now has a purpose to her life.
Pathfinders gets its support from three major sources – U.S. Agency for International Development for food aid; Global Fund for AIDS, TB and Malaria for behavior change communication and education in HIV, tuberculosis and malaria; and GHC member Academy for International Development (AED), though AED’s support is ending and Mrs. Ulzen-Christian has no idea how they will carry on without it.
The Advisory Board is in Accra for their annual meeting in which they are examining the Candlelight Memorial event from last May and planning for the next one in 2010. The Advisory Board is made up of two regional coordinators from each of the six regions in the world – North America, Latin American and Caribbean, Europe, West and Central Asia, East and South Asia and Africa.
As the adorable toddlers scampered into their arms and our laps, we heard Becklyn Ulzen-Christian, Pathfinders executive director, describe the care she and her staff provide for orphans and vulnerable children and HIV-positive adults in the face of limited resources, great stigma against HIV-positive people and other challenges.
Pathfinders looks after 70 children, 13 of whom lives at the facility, and many HIV-positive adults who have been rejected by their families and friends. We talked to Felicia, a middle-aged woman whose hard life is etched on her face, who has been HIV-positive for 17 years. She said she has found a new life in the warmth of Pathfinders and now has a purpose to her life.
Pathfinders gets its support from three major sources – U.S. Agency for International Development for food aid; Global Fund for AIDS, TB and Malaria for behavior change communication and education in HIV, tuberculosis and malaria; and GHC member Academy for International Development (AED), though AED’s support is ending and Mrs. Ulzen-Christian has no idea how they will carry on without it.
The Advisory Board is in Accra for their annual meeting in which they are examining the Candlelight Memorial event from last May and planning for the next one in 2010. The Advisory Board is made up of two regional coordinators from each of the six regions in the world – North America, Latin American and Caribbean, Europe, West and Central Asia, East and South Asia and Africa.
Sunday, September 27, 2009
Much has changed in Accra but not everything...
ACCRA, Ghana -- The last time I was in Ghana was 1985, when I had just finished two years of Peace Corps service and my wife and I had traveled there from Togo in order to catch an Egypt Air flight to Cairo. Here's what I wrote in my diary on Oct. 13, 1985:
"We didn't particularly enjoy Accra. It's a decaying city where it's hard to find items we would take for granted in Lome. The first night we ate dinner at a Chinese restaurant. Fewer than half the items available on the menu were available. On the second day, we took a taxi into the decaying and filthy downtown and found a decaying hotel on the ocean. We looked down on a once-beautiful swimming pool that was now empty and decaying. We were very thirsty. All they had to drink was beer and tonic. I didn't want beer or tonic so I stayed thirsty. When I asked for a glass of water the water said 'It is finished.' That remark will be one of my strongest impressions of Ghana: 'The water is finished.'"
Note the number of times I used the word "decaying" in that short passage.
Those were the bad old days, when Ghana had a dysfunctional economy and food shortages so severe that Peace Corps Ghana had to truck in food from Togo for its volunteers. Fortunately, those days are gone and Ghana now has a vibrant economy and democracy that recently had a peaceful transfer of power after a closely contested election. That is why President Obama had chosen to make it the destination of his first trip to Africa as president.
I arrived here yesterday for my second visit. The Global Health Council manages the AIDS Candlelight Memorial, the world's largest and oldest AIDS awareness raising event, and we are meeting with our regional coordinators from around the world. I found that many things have changed, and for the better, but a few have not.
On my first night in Accra, my two colleagues and I went out to eat at Buku, an African restaurant in the Osu neighborhood, as the Lonely Planet Guide to West Africa had recommended it for its Ghanian, Nigerian, Togolese and Senegalese food. It was a lovely place but I ran into a similar problem from my first trip, albeit no quite so severe. They had no dressing for my salad, they had run out of guinea fowl and had no ginger beer. But they did have most things and we had a delicious dinner in the open air and under a straw roof. I had groundnut (peanut) stew with goat (instead of guinea fowl!), fried plantains and Star beer. All in all, Ghana is vasty improved and I am thrilled to be back in West Africa.
"We didn't particularly enjoy Accra. It's a decaying city where it's hard to find items we would take for granted in Lome. The first night we ate dinner at a Chinese restaurant. Fewer than half the items available on the menu were available. On the second day, we took a taxi into the decaying and filthy downtown and found a decaying hotel on the ocean. We looked down on a once-beautiful swimming pool that was now empty and decaying. We were very thirsty. All they had to drink was beer and tonic. I didn't want beer or tonic so I stayed thirsty. When I asked for a glass of water the water said 'It is finished.' That remark will be one of my strongest impressions of Ghana: 'The water is finished.'"
Note the number of times I used the word "decaying" in that short passage.
Those were the bad old days, when Ghana had a dysfunctional economy and food shortages so severe that Peace Corps Ghana had to truck in food from Togo for its volunteers. Fortunately, those days are gone and Ghana now has a vibrant economy and democracy that recently had a peaceful transfer of power after a closely contested election. That is why President Obama had chosen to make it the destination of his first trip to Africa as president.
I arrived here yesterday for my second visit. The Global Health Council manages the AIDS Candlelight Memorial, the world's largest and oldest AIDS awareness raising event, and we are meeting with our regional coordinators from around the world. I found that many things have changed, and for the better, but a few have not.
On my first night in Accra, my two colleagues and I went out to eat at Buku, an African restaurant in the Osu neighborhood, as the Lonely Planet Guide to West Africa had recommended it for its Ghanian, Nigerian, Togolese and Senegalese food. It was a lovely place but I ran into a similar problem from my first trip, albeit no quite so severe. They had no dressing for my salad, they had run out of guinea fowl and had no ginger beer. But they did have most things and we had a delicious dinner in the open air and under a straw roof. I had groundnut (peanut) stew with goat (instead of guinea fowl!), fried plantains and Star beer. All in all, Ghana is vasty improved and I am thrilled to be back in West Africa.
Friday, September 25, 2009
G20 proves frustrating but Pittsburghers a delight
PITTSBURGH -- I just spent two days at the G20 Summit here trying to keep global health on the leaders' agenda, as it had been in Washington in November 2008 when they pledged to work on achieving the Millennium Development Goals. But it was completely absent from their agenda in Pittsburgh. This was a disappointment, but the incredible graciousness of Pittsburghers helped make up for it. A few examples:
The night before the opening of the summit, I was having a drink with a friend at a bar across the street from Pirates Stadium where the Pirates were playing the Reds. I would have like to have gone but we were headed for a party in a couple of hours. Imagine my delight when a man came by and dropped two free tickets on us. Five minutes later we were inside the stadium with a very sparse crowd (people were not coming downtown because of the G20) on a beautiful September evening sitting in very good seats!
We had to leave early to attend a party hosted by Teresa Heinz Kerry to raise support for the fight against global warming at the Andy Warhol Museum which, by the way is fantastic. There was great New Orleans music - Cajun, rock and jazz -- and great food and drink. Not to mention the art of Andy Warhol. When we were leaving about midnight, we could not find a taxi and when we called were told that one could not come in less than 45 minutes. A lovely couple overheard us and offered us a ride to our hotel -- even though it was in the opposite direction from their house!
And on the last day of the summit, two Save the Children colleagues and I were walking to the media center through downtown Pittsburgh with a very high level of security. Even though it was Friday, very few places were open. But when we spotted a coffee shop with the catchy name of "Crazy Mocha" we had to stop. When we walked into the shop, the two employees cheered and applauded us. They were so bored from the lack of customers, that they had to express their joy at seeing us!
Pittsburgh is a far more interesting city than I every imagined populated by warm, wonderful and quirky people and I would go back anytime. A very underated and very American city! I highly recommend it.
The night before the opening of the summit, I was having a drink with a friend at a bar across the street from Pirates Stadium where the Pirates were playing the Reds. I would have like to have gone but we were headed for a party in a couple of hours. Imagine my delight when a man came by and dropped two free tickets on us. Five minutes later we were inside the stadium with a very sparse crowd (people were not coming downtown because of the G20) on a beautiful September evening sitting in very good seats!
We had to leave early to attend a party hosted by Teresa Heinz Kerry to raise support for the fight against global warming at the Andy Warhol Museum which, by the way is fantastic. There was great New Orleans music - Cajun, rock and jazz -- and great food and drink. Not to mention the art of Andy Warhol. When we were leaving about midnight, we could not find a taxi and when we called were told that one could not come in less than 45 minutes. A lovely couple overheard us and offered us a ride to our hotel -- even though it was in the opposite direction from their house!
And on the last day of the summit, two Save the Children colleagues and I were walking to the media center through downtown Pittsburgh with a very high level of security. Even though it was Friday, very few places were open. But when we spotted a coffee shop with the catchy name of "Crazy Mocha" we had to stop. When we walked into the shop, the two employees cheered and applauded us. They were so bored from the lack of customers, that they had to express their joy at seeing us!
Pittsburgh is a far more interesting city than I every imagined populated by warm, wonderful and quirky people and I would go back anytime. A very underated and very American city! I highly recommend it.
Tuesday, September 22, 2009
Berlin Delegates Demand Adoption of ICPD Agenda
BERLIN, Germany – Four hundred delegates from 130 countries released the “Berlin Call to Action” earlier this month at the NGO Forum on Sexual and Reproductive Health and Development that followed up on the historic International Conference on Population & Development held in Cairo 15 years ago.
After long and sometimes heated discussions, the delegates demanded that donors and governments accelerate implementation of the ICPD Program of Action “as fundamental to achieving equality and equity, human rights and social and economic development.” They urged the following actions to be taken immediately:
1. Guarantee that sexual and reproductive rights, as human rights, are fully recognized and fulfilled. This reflects the delegates’ desire to go beyond the realm of public health and position sexual and reproductive rights as fundamental human rights.
2. Invest in comprehensive sexual and reproductive health (SRH) information, supplies and services as a priority in health system strengthening. The new idea here is to acknowledge the fact that the current aid architecture emphasizes health system strengthening and the delegates belief that associating SRH with health systems can help our cause.
3. Ensure the sexual and reproductive rights of adolescents and young people. Approximately 25% of all of the delegates were under the age of 30 and the focus on youth was a recurring theme of the conference. Jill Greer, chair of the Steering Group, said that it was vital that the movement develop new leaders for the future.
4. Create and implement formal mechanisms for meaningful civil society participation in programs, policy and budget decisions, monitoring and evaluation. The message here is that governments have to bring civil society organizations to the table as meaningful partners.
5. Ensure that donor contributions and national budgets and policies meet the needs of people for sexual and reproductive health and rights. This financial aspect was enhanced considerably from the earlier draft and reflects the delegates’ recognition that their lofty visions will not be realized without the financial resources to carry them out.
Sivananthi Thanenthiran, a co-chair of the Steering Group, recognized that the most intractable hurdle to overcome in finalizing the text was the split between those who preferred ICDP language, and those who preferred the language of the Millennium Development Goals. “We have positioned ourselves in the middle,” said Ms. Thanenthiran. “We want to move beyond Cairo and leverage the MDGs.”
Another key issue was toning down the rhetoric because of the fundamentalism of many countries where the legitimacy of governments is based on religion. To overcome this, the Drafting Committee tried to find language that would not offend.
After long and sometimes heated discussions, the delegates demanded that donors and governments accelerate implementation of the ICPD Program of Action “as fundamental to achieving equality and equity, human rights and social and economic development.” They urged the following actions to be taken immediately:
1. Guarantee that sexual and reproductive rights, as human rights, are fully recognized and fulfilled. This reflects the delegates’ desire to go beyond the realm of public health and position sexual and reproductive rights as fundamental human rights.
2. Invest in comprehensive sexual and reproductive health (SRH) information, supplies and services as a priority in health system strengthening. The new idea here is to acknowledge the fact that the current aid architecture emphasizes health system strengthening and the delegates belief that associating SRH with health systems can help our cause.
3. Ensure the sexual and reproductive rights of adolescents and young people. Approximately 25% of all of the delegates were under the age of 30 and the focus on youth was a recurring theme of the conference. Jill Greer, chair of the Steering Group, said that it was vital that the movement develop new leaders for the future.
4. Create and implement formal mechanisms for meaningful civil society participation in programs, policy and budget decisions, monitoring and evaluation. The message here is that governments have to bring civil society organizations to the table as meaningful partners.
5. Ensure that donor contributions and national budgets and policies meet the needs of people for sexual and reproductive health and rights. This financial aspect was enhanced considerably from the earlier draft and reflects the delegates’ recognition that their lofty visions will not be realized without the financial resources to carry them out.
Sivananthi Thanenthiran, a co-chair of the Steering Group, recognized that the most intractable hurdle to overcome in finalizing the text was the split between those who preferred ICDP language, and those who preferred the language of the Millennium Development Goals. “We have positioned ourselves in the middle,” said Ms. Thanenthiran. “We want to move beyond Cairo and leverage the MDGs.”
Another key issue was toning down the rhetoric because of the fundamentalism of many countries where the legitimacy of governments is based on religion. To overcome this, the Drafting Committee tried to find language that would not offend.
Monday, August 24, 2009
Markets have a role in malaria treatment
By sheer serendipity, I happened to pick up a copy of The Guardian (link text), my favorite British newspaper, in London last Thursday and saw an interesting piece on the challenges in providing malaria treatment by Sarah Boseley, the Guardian health editor. I thought Sarah captured very well the dire lack of Coartem malaria treatment in most of the country. But I was dismayed by the way she suddenly turned against the role of the market in providing such treatment at the very end of her story, even after admitting the failure of the public sector to do so and praising the ability of companies like Coca-Cola to make their products widely available.
So I felt compelled to challenge her dissing of the potential for markets to contribute to health care in developing countries, and today my letter was published in The Guardian.
And here is the story of my own encounter with malaria treatment in Uganda based on my trip to Uganda in 2008, and which I cited in my letter.
So I felt compelled to challenge her dissing of the potential for markets to contribute to health care in developing countries, and today my letter was published in The Guardian.
And here is the story of my own encounter with malaria treatment in Uganda based on my trip to Uganda in 2008, and which I cited in my letter.
Saturday, August 8, 2009
AIDS prevention must be more of a priority
Everyone working in HIV/AIDS -- as I have been for 17 years since I founded Society for Family Health, the leading HIV prevention organization in Zambia in 1992 -- has heard the aphorism "We can't treat our way out of this epidemic" and everyone knows that for every person that goes on treatment, there are several more new infections.
Both Randall Tobias and Mark Dybul, the first two PEPFAR coordinators, always said that HIV prevention was a priority. But in reality, prevention was never a priority with PEPFAR and could never be a priority since the law that created PEPFAR hamstrung prevention efforts by limiting them to 20% of the budget. And the bitter political battles swirling around HIV prevention during the eight Bush years prevented an evidence-based formula for measuring the number of HIV infections from being implemented. Instead, PEPFAR was reduced to measuring prevention with process indicators such as messages transmitted and campaigns conducted.
I thought of all of this today when reading the press accounts of the visit of Secretary of State Hilary Clinton to HIV/AIDS programs supported by the U.S. government in South Africa. Treatment dominated Secretary Clinton's visit and understandably so, given the fact that South Africa has more HIV-positive people than any other country in the world. But where is prevention in all of this? After all, even South Africa, with its vastly greater resources as compared to any other sub-Saharan African country, cannot treat its way out of its epidemic.
That is why I was so pleased to see, hidden at the end of today's Washington Post account of Secretary Clinton's visit to South Africa, the following paragraph:
"U.S. Rep. Nita M. Lowey (D-NY), the head of the House Appropriations subcommittee that funds foreign aid programs, said at the ceremony that she hopes to see more assistance going toward prevention, rather than just treatment."
Bless the heart of Rep. Lowey for reminding us of this simple fact: We will never get ahead of the AIDS pandemic until we focus more on prevention, which continues to be grossly neglected. It is so much easier -- although much, much less cost-effective -- to treat people after they have been infected than to prevent the infection in the first place.
And it is awfully messy -- not to mention politically perilous -- to protect injecting drug users, sex workers and the men who patronize them, and even more controversial when we direct efforts at adolescents who most adults would prefer to pretend will be celibate until marriage.
Thanks to Rep. Lowey for reminding us of the importance of prevention, and let's hope Eric Goosby, the incoming PEPFAR coordinator, hears her plea, and directs more PEPFAR resources into prevention, finally. The future of the pandemic depends on it.
Both Randall Tobias and Mark Dybul, the first two PEPFAR coordinators, always said that HIV prevention was a priority. But in reality, prevention was never a priority with PEPFAR and could never be a priority since the law that created PEPFAR hamstrung prevention efforts by limiting them to 20% of the budget. And the bitter political battles swirling around HIV prevention during the eight Bush years prevented an evidence-based formula for measuring the number of HIV infections from being implemented. Instead, PEPFAR was reduced to measuring prevention with process indicators such as messages transmitted and campaigns conducted.
I thought of all of this today when reading the press accounts of the visit of Secretary of State Hilary Clinton to HIV/AIDS programs supported by the U.S. government in South Africa. Treatment dominated Secretary Clinton's visit and understandably so, given the fact that South Africa has more HIV-positive people than any other country in the world. But where is prevention in all of this? After all, even South Africa, with its vastly greater resources as compared to any other sub-Saharan African country, cannot treat its way out of its epidemic.
That is why I was so pleased to see, hidden at the end of today's Washington Post account of Secretary Clinton's visit to South Africa, the following paragraph:
"U.S. Rep. Nita M. Lowey (D-NY), the head of the House Appropriations subcommittee that funds foreign aid programs, said at the ceremony that she hopes to see more assistance going toward prevention, rather than just treatment."
Bless the heart of Rep. Lowey for reminding us of this simple fact: We will never get ahead of the AIDS pandemic until we focus more on prevention, which continues to be grossly neglected. It is so much easier -- although much, much less cost-effective -- to treat people after they have been infected than to prevent the infection in the first place.
And it is awfully messy -- not to mention politically perilous -- to protect injecting drug users, sex workers and the men who patronize them, and even more controversial when we direct efforts at adolescents who most adults would prefer to pretend will be celibate until marriage.
Thanks to Rep. Lowey for reminding us of the importance of prevention, and let's hope Eric Goosby, the incoming PEPFAR coordinator, hears her plea, and directs more PEPFAR resources into prevention, finally. The future of the pandemic depends on it.
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