Triple Helix

Writing this in the Suntreso Government Hospital right now, over an MTN HSPA connection. We’re waiting on a gas station owner to come by and take us to his business. We’ll be installing a machine without electronics today. Helena, the Data Manager of the hospital and our main interlocutor, has said that she really wants a machine with usage monitoring in the hospital. Edward and I will be working on assembling one of those this afternoon.

Our biggest challenges thus far have been adapting the machine to the Ghanaian context. Replacement parts are not readily available, and Helena is worried that the machines will empty very quickly. It is becoming immediately obvious that what we truly need is a locally-made machine. One that can be easily modified to accept the correct amount of money for market rates, and dispense condoms that do not require more packaging than absolutely necessary. We are also hoping that there is someone at KNUST that could work on the electronics component.

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)

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.