Family Planning Clinic and Makola Market- June 21

 Wednesday June 21 

There was tons of traffic on our way to the hospital today. There are certainly peak times for it but it’s sometimes randomly very slow. Today our Bolt driver was listening to a radio station where they were discussing “land guards”, which seem like privately hired guards that defend land, not so much in Accra but in rural areas. They sound controversial, most people who called in were saying that they are too lawless or violent and should be stopped by police, but one woman described her situation of her house being filled by squatters whom her landlord collected rent from and not being able to get them to leave for a year until she hired land guards. 

Today I went to the family planning clinic. First-time patients can walk in but returners have appointments. The main nurse said that most women who come in already have children but some don’t have any yet and they do sometimes have teen girls come in. 

Here are some posters that are on the wall that warn against having kids too young or too close in age. 

They do not do IUDs here, they do arm injections but also use a somewhat new self injectable that I also saw posters for at the family planning clinic at the Jamestown maternity ward. For that, they come in for the first two injections then are given the medication and do it from home every 3 months after. 

They also do arm implants that last up to either 3-5 years. One woman came in and had hers removed because it had been 5 years and  she decided to switch to the injectables. 

They have a main desk area where they see the patient and check their weight and BP and do the injectable, and they also have a bed in the back where they do the implants. They would also send each woman to take a basic pregnancy test before each visit. 

They said that women do experience side effects some times so they might stop or switch birth control. But, they said one of the main side effects women complain of is their period stopping, which they have to explain is normal since the egg isn’t being released. 

They have flipbooks that list the different options (although they list things like IUDs or vasectomies that are not actually really available here). Each patient is given a small record book at their initial visit but if they lose it, they don’t replace it and instead give them a makeshift booklet made of the thin cardboard from the medication boxes. 

Alberta and Roberta are the directors of this clinic, they aren’t doctors but I think they have a nursing background. They were present here along with a nurse who did some of the injections, and another person who took notes and assisted. 

They said that birth control is definitely stigmatized here. Most women come without any of their family or husbands knowing. Some don’t even want to take the record book home in case someone would see it. 

They do sell condoms here, 3 for 1 cedi, and she said they don’t give them out for free because they want them to value it. The condoms they had were from a peer who was randomly given them while visiting the national theater and some convention was happening where they were giving them out. So, I’m not sure how many they usually have that they get on their own. They did have female condoms. I have seen some condoms for sale at ShopRite although it was not a big display in the aisle, it was a small set of them for sale by the checkout. 

They said that insurance should cover half the cost if they have insurance but that it’s not very expensive either way (the visits I saw were about 15-40 cedis depending on what they got, which is less than 4 US dollars). They would hand the money directly to the nurse during the visit. 

I asked about sex education here and they said that they go into schools to give talks (the teachers don’t do it themselves). There are 14 schools that this clinic will go to and they go once a year to each one. They will give a general talk about health and depending on the age, they will also talk about menstrual health and hygiene. They are not allowed by the Ghana Health Service to talk about family planning/birth control. One of my peers did attend a school visit where they talked about STI prevention but they couldn’t talk about birth control. 

The visits also include some general checkups on the kids and sometimes vaccines. They said that if a child has a problem they tell them they can come to the clinic so it’s more discreet if it’s something related to sexual health. 

The clinic didn’t have anyone come in for the last hour or so so I left and had lunch. Then, two peers and I went to Makola Market.

Makola Market is the biggest open air market in Accra and is just down the street from the hospital. It was drizzling on and off and also was a weekday so I think that helped make it not super crowded (it was still very crowded, just not packed in all areas the way I’ve seen photos of it). We walked around for a while; the Marley spanned several streets and was very spread out. 

There were people selling pretty much everything; food, clothes, jewelry, tons of shoes, bath products, etc. There were lots of vendors lining the streets but also lots of women walking with baskets full of things to sell on their heads. 

We bought some fresh coconut which was really good, as well as sugar cane which was a stalk that you chew and then spit out. We also bought tiger nuts, a crunchy root sphere that tastes like coconut and you also chew and then spit out. 

I also bought a dress. Originally when we were looking for dresses, we thought we’d have to buy fabric and take it to a dressmaker because that is very common here; fabric shops are on almost every street and so are tailor shops. But, I was able to find some pre-made dresses at a shop. 

The vendor told me it was 75 cedis for the dress, which I thought was very cheap (about 7 US dollars) but I asked for 70 since you’re supposed to bargain which she agreed to. My peers said I should’ve gone lower (a rule of thumb is to pitch 50% of the price they give you then meet at 75%) but it seemed so cheap I didn’t ask for lower. Things definitely cost much lower here than in the US; you can get a huge meal for 7-10 US dollars; an hour long Bolt car ride is about 10 US dollars, etc. Whenever we Venmo for rides to places around town we’ll be sending each other like 2-3 dollars!

I haggled the price of some bracelets and some fruit and got some brought down slightly. 

One of my peers who was with us who is black is often assumed to be a local and they would propose cheaper prices to her. When buying the sugar cane, she got a bag for 2 cedis, I got one for 3. Sometimes they'd talk to her in Twi.

We definitely heard “white woman! Obruni!” a dozen times while walking around; at the end when we reached the outskirts, some men were trying to talk to us more or grabbing our arms a few times.

Despite it being a crowded market, cars would still drive on the streets so we had to be careful to dodge cars and motorcycles with people weaving in and out. 

We had to ask for directions a few times back to the hospital because the streets were confusing and we had walked all around but we found our way back and ordered a car.

As we were in the car back home, it started torrentially pouring so we were glad we finished the market when we did. You can see the rain in this picture.

I considered going swimming but most of the roads would have been kinda flooded so I didn’t go and did a body weight workout then had leftovers for dinner. One of my peers cooked a steak with lots of pepper seasoning and it made all of us in the room start coughing and sneezing, whatever it was really spread across the room and there isn't good ventilation or oven fans here.

We then went to bed.