Last Night in Kumasi

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One of many cell phone towers in Kumasi stands by the road.

Tonight is our last night in Kumasi. We’ve accomplished and learned a great deal, but it is obvious that this is just the beginning. We brought a SMS condom-finding service, thinking that there was a problem of information, not acceptance. We now realize that most people know where the condoms are, (and those places are close-by) but the stigma and anxiety over purchasing a condom is a major deterrent. We will not be installing the SMS system before we leave, but will use it as a starting point for continued research.
We must now look for ways to 1) reduce the stigma surrounding condom purchasing and usage. By incorporating regular condom use within a culturally-informed ad campaign that uses well-known local symbols, we aim to change popular perceptions about what it means to use a condom. 2) We must provide a way to make condom purchasing less intimidating by providing anonymity and convenience. We hope to achieve this by setting up condom vending machines in private places. To be sure, we do not want to drive condom purchasing into the shadows- rather we want to make it easier to purchase condoms using a variety of methods that have differing levels of human interaction and publicity. This also opens up opportunities for social entrepreneurship (managing vending machines)

Developments in Condom Acceptance and Texting Habits

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A vendor cells a wide range of cellular phones at a central market in Kumasi.

Interviews have been coming in fits and spurts. I’ve finished about ten interviews at the hospital’s chronic disease and family planning unit. The people at the hospital have been very accommodating and have really made this project mature into a promising piece of academic work as well as a useful tool for Ghanians. Cell phone use patterns have been very interesting. Many Ghanians have multiple cell phones and use them for Facebook, Twitter, email, texting and calling. Some have multiple phones because of network availability, while others designate specific phones for one of the functions just listed.

The second half of the project, condoms, is much more complicated. Condoms occupy a complicated position in Ghanaian society. While they are widely available, and appear to sell very well, the stigma attached to buying one (especially if you’re a woman) are relatively high. Many people expressed that they felt shy, awkward, or even scared when asking for a condom at a pharmacy. While this may not sound much different than how it is in the US, it appears as though the intensity of the negative feelings is higher and more uniform across most people. (The one exception being those enrolled in university. I imagine this might have to do with socio-economic correlations.) We also visited about eight pharmacies and I asked the employees about condom sales. Most were happy to talk about it, but only one store had them displayed above the counter, at a reasonably viewable height. Most were behind the counter or up on top of a high shelf. Employees said they kept them slightly hidden so that one may purchase them inconspicuously, but still see them for sale. Most people assume that a pharmacy will have condoms in stock. They could be cheaper, but are not horribly expensive. No one has reported seeing a condom package with a dark-skinned person on it. They are all light-skinned Europeans or Asians. The condoms appear to be made primarily in China and India.

This means that our original assumption -that there was a problem of information, not acceptance- was inaccurate. While the condom-finding texting system has gotten positive feedback, it doesn’t seem to attack the bigger problem of acceptance. We plan on brainstorming with hospital employees tomorrow, and consider new approaches to making the purchase of condoms a more comfortable experience.

The next half of the week promises to be tough, but I can see a breakthrough on the horizon.

The Journey

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Its 11:00PM and I think we’re almost at Kumasi. The lack of road signs and personal geographical knowledge makes it difficult to tell. We’re driving in a tiny Toyota bus piloted by a very good driver. We’ve passed, driven over, swerved around, and nearly hit just about everything under the sun, but remain safe and relatively comfortable. All of this, accompanied by a wonderful soundtrack, care of a radio station that plays exclusively Michael Jackson hits and 80s European synth-pop.

Both Dan and I had a similar first impression of Ghana- it looks a lot like Georgia. The similarities are somewhat striking. Similar natural resources: gold, fruit, and tubers, all buried in orange clay. The advent of cheap cars has caused the economy to lurch forward in fits and starts. You can see a man selling you apples on the side of the road and no sooner do you look over his shoulder, do you see the rising cranes that are busy assembling the new high-rise apartments next to the shopping mall. Buying something outside of a mall seems to entail buying it out of a shipping crate that has been converted into a store front. They’re painted with bright advertisements for Vodafone, airtel, glo, and MTN, the major cell phone providers in Ghana. Its hard to exaggerate how pervasive cell phone companies are here. You can’t go too far without seeing advertisements or a SIM card vendor.

Speaking of cell phones, Audrey and I will be meeting Helena tomorrow for lunch, where we’ll be planning some of our future meetings with Ghanaians receiving treatment in her STI clinics. We’ll be asking them about condom use and access. Tomorrow will also be spent finding our luggage. None of our checked bags navigated the cancelled, delayed, and rerouted transatlantic flights to Accra. Hopefully they’ll come on tomorrow’s plane and a driver will get them from the airport and deliver them to the University. Given our one false start and the day’s difficulties, everyone is still in good spirits and generally excited to get to our good work.