AN OVERVIEW OF GHANA

Ghana is a West African country on the Gulf of Guinea. Portuguese explorers landed in what is now Ghana in 1471. They found so much gold there that they called it the “Gold Coast.” Later, European merchants came to the Gold Coast to compete for profits in the gold and slave trades. In the late 1800’s the Gold Coast became a British colony. It gained its independence in 1957, the first African colony to do so, and took the name “Ghana,” the name of an ancient African kingdom. In 1960, the people voted to become a republic and elected Kwame Nkrumah president. His “socialist” experiment was a disaster. After his overthrow in 1966, there have been five military regimes and three short-lived civilian governments. The revolutionary military government of Jerry Rawlings eventually opened the way for multi-party elections in 1992. He was democratically returned to power and served as President through two terms (the maximum allowed by constitution), until the elections of December 2000.

Leading exports from Ghana are cacao, gold, and timber. After an almost total economic collapse in 1982, they are now making a steady recovery with an average GDP growth of 5% per annum. Average annual income per person is $410.00.

There are about 75 different ethnic groups in Ghana that speak 72 different languages. Primary, secondary, and technical education is government subsidized and most children can attend school until they are about 12 years old. Fifty-three percent of the population (in the cities) can read and write; however, the percentage in the rural areas is quite low. There are five universities plus a large number of teacher colleges and technical institutes.

Ghana is an agricultural country; 59% of the population is employed in agriculture. Cacao is the principle agricultural export. It also has important mineral deposits, exporting gold, diamonds, and bauxite. Of a total population of 19,271,744 (2000 figures), 70% live in the southern half of the country, with 37% living in urban areas. In the north, virtually all are subsistence farmers (see map above; scale is for the blue map of Ghana).

The terrain is mostly savannah with gently rolling hills. Although the southern part of the country has enough rain to sustain localized rainforest, the northern areas have two very distinct seasons, rainy and dry. The rainy season lasts from approximately May or June through September or October. During this time it rains every two to four days; the rain can be torrential but usually only lasts one to two hours at a time. The land is lush and green, with temperatures ranging from 70° F at night to maybe 90° F at midday. This is the prettiest season but also when mosquitoes are in greatest numbers. The dry season usually begins in October and continues until about May, during which there is virtually no rain at all. Temperatures can easily surpass 100° F, even reaching 110° and sometimes 115°; the nights remain warm, at times not cooling below 90° F. From approximately late November until late February we experience the Harmatan: winds blow south from the Sahara, bringing a fine white dust that hangs in the air like fog, often blocking the sun to a significant degree. This dust gets inside your house and will enter any closet or drawer that isn’t airtight.

Ghana is a secular state with religious freedom. The quoted figures regarding the breakdown of religious affiliation vary from source to source; this quote from the 2001 edition of the Microsoft Encarta Encyclopedia Standard will give you general idea of what’s found here: “ Traditional religions, adhered to by two-fifths of the population, generally involve some form of animism. The Christian population, which accounts for two-fifths of the total population and includes Roman Catholics, Protestants, and indigenous African sects, is concentrated in the coastal region. The Muslim population (12% of the total) is located chiefly in the northern part of the country.” The “traditional religions” mentioned above are various forms of animism or spiritism, most often called African traditional religion, and are practiced by most peoples in the north.

Baptist work in Ghana began with the first missionary under the International Mission Board (then the Foreign Mission Board) in 1947. Medical work in northern Ghana had begun using a mobile clinic unit; years of praying and planning culminated in 1958 when Baptist Medical Centre (BMC) was fully opened. Dr. George Faile and a few Ghanaian workers began holding daily clinics. Although initially only an outpatient clinic it was later expanded to include inpatient care, including surgery. The 1960s brought additions to the hospital, including the residential tuberculosis program, which began addressing one of the major health problems in the area.

The 1970s saw further additions for BMC, as well as a serious measles outbreak. In 1978 BMC’s medical staff performed an emergency mass immunization of more than 45,000 children. This even opened doors for a strong witness among people otherwise unreached in the area. The hospital’s public health program was established the following decade, a work that has allowed a witness to some villages with no evangelical church.

The 1990s brought a crisis that has become a defining event for BMC. In early 1997 an epidemic of cerebrospinal meningitis brought hundreds of extra patients to the hospital. Through the hard work of our staff, government support, Doctors Without Borders, and, above all, the provision of our Lord Jesus Christ, BMC emerged from this stressful time stronger than ever. The staff’s efforts during the crisis prompted national recognition. Ghanaian President Flt. Lt. Jerry Rawlings honored the hospital with two official visits in 1997 and awarded BMC Ghana’s Medal of Honor for its service in the Northern Region.

Baptist Medical Centre is located in the village of Nalerigu, in the Northern Region, specifically at 10° 31 N lat. and 0° 22 W long. BMC is a 105-bed hospital (inpatient census often runs 120 or higher) that offers full inpatient services. The clinic is open Monday, Wednesday, and Friday every week except public holidays. In recent years the yearly statistics have been averaging as follows: 60,000 outpatient visits, 10,000 inpatients, 1,000 major operations, and 2,500 minor procedures. Forty churches have been planted as a direct result of the ministries associated with BMC.

Some pronunciations to assist you:

Certain days see more traffic at the airport than others and the resulting crowds can make your arrival quite hectic. We recommend that, if at all possible, you avoid arriving on Wednesdays or Fridays (especially Fridays). If this cannot be avoided simply keep in mind that it may take you a bit longer to get through customs and there will be a larger crowd to fight through on the way to the car.

We recommend that, if possible, you allow yourself one or two days in Accra before heading north for BMC as this will allow your body time to begin overcoming jet lag and recuperate from the long travel (typically 20 to 24 hours from the U.S., including layovers). If you’re going to be doing your own cooking you will also need to do some grocery shopping (and register with the Ministry of Health, if you’re a physician – see below). We acknowledge that this isn’t always possible, it’s just ideal. We would also suggest that you consider, schedule permitting, allowing yourself two to four days between your departure from Nalerigu and your flight out to enjoy some of the sights and experiences that Ghana has to offer. There’s a game park between Kumasi and Tamale, a rain forest near the coast with a canopy walk (one of only three in the world), old forts (“castles”) to tour, and several very nice coastal resorts. There’s good souvenir shopping in and near Kumasi and Accra, including “Kente village” where you can purchase articles made from (or even entire sheets of) Kente cloth. The missionaries will guide you to the best places to shop and offer guidelines on prices, how to bargain, etc.

Even with e-mail, fax, and telephone capability now available to us, there have been (rare) times that volunteers have arrived at our airport and we were unaware of their coming. The Mission Board usually is very good about communication but there have been times, due to personnel changes, office relocations, etc. that we have received no advance information from our stateside mission offices. We feel that the most reliable approach is for you to assume that we have received no information about your travel except what you have sent to us. Use the above means of communicating directly with us, or drop us a note in the mail to let us know your itinerary. It’s also critical that you send your itinerary to the hostel in Accra, where you will stay just after your arrival in, and just before your departure from, Ghana. The hostel staff will meet you at the airport upon your arrival. Following are the means by which you may contact us (remember that Ghana is in the GMT zone and, therefore, is five hours ahead of EST; during EDT, it’s four hours).

Hostel: Ghana Baptist Mission Hostel: telephone: 011-233-021-777542 (M – F, 8 – 4 GMT)

Nalerigu: Baptist Medical Centre Telephone: 011-871-761-475-715 (M – F, 8 – 4 GMT)

Ghana, West Africa NOTE: The 011 prefix listed above is used to call from the U.S.A. only.

As a general rule, for insurance considerations, most short-term volunteers are not assigned a vehicle by the team. However, if you will be staying for an extended period of time it would be good for you to obtain an International Driving Permit through AAA. Failing this you should bring your USA drivers license so that you can obtain a Ghana Driving Permit, if necessary (there would be a small fee for this and would require two passport photos). Our current mission policy is that volunteer personnel can only drive a mission vehicle on the hospital compound, specifically medical personnel on call at night.

NOTE: Additional passport-type photos will also be needed if you need to renew or extend your visa. In fact, any kind of official paperwork in Ghana requires two or three pictures. It’s fairly easy and cheap to get these made in one of the major cities (but do this before you get to Nalerigu) or you may wish to simply bring extras with you from the U.S.

The most frequent health problem encountered by our missionaries is malaria and volunteers are certainly not immune to it (although most of our visitors do not develop malaria). This is parasitic infection caused by the bite of the Anopheles mosquito, which has its highest level of activity from dusk to dawn (but can be seen any hour of the day). The symptoms of malaria vary from case to case but most often one will experience a flu-like illness with fatigue, generalized aches and pains, headache, and diminished appetite; sometimes nausea, vomiting, and/or diarrhea, and perhaps fever and/or chills.

As volunteers, you should take prophylactic medication for the prevention of malaria beginning at least two weeks before you arrive. The two most common prophylactic regimens include either mefloquine (Larium) or chloroquine (Aralen). Both of these medications are taken as a once weekly dose, although some here choose to add a daily prophylactic medication consisting of either proguanil (Paludrine) or doxycycline (Vibramycin). If you choose a daily prophylaxis in addition to the weekly regimen, the daily medication can be initiated upon arrival in the country. Paludrine is not available in the USA but can be bought locally. It is important that you consult your regular physician and/or IMB volunteer section for further advice about when to begin malaria prophylaxis as doctors have differing opinions about this. They will be able to advise you of the proper dose of the medication you choose. Unfortunately, in spite of our best efforts at prevention, some volunteers still get malaria. For an acute attack of malaria, the treatment medications might include chlororuqine, mefloquine, Fansidar, quinine, or other drugs uncommon in the USA. It is important to know if you are allergic to sulfa drugs (those that contain sulfur compounds) because this would preclude the use of Fansidar (commonly used as the second of a two-drug treatment approach for malaria). Also, some of these medications are not used in pregnancy or by young children. Once again, it is important to consult with your regular physician and/or the IMB concerning anti-malarial medications.

In addition to chemical prophylaxis, it is practical to employ other measures of malaria prevention. It is strongly recommended that you use an insect repellent before going out at dusk or later. The most effective repellent available is DEET and current recommendations are that you use a repellent containing a DEET concentration of 20 – 35%. Before purchasing a large supply, test what you choose to be certain that it won’t cause a skin reaction. Other measures include reducing your exposure to mosquitoes by avoiding outdoor activities when mosquitoes are most active or by wearing long-sleeved clothing and trousers while outdoors at those times (light-colored clothing seems to be least attractive to mosquitoes). Remember the adage that “an ounce of prevention is worth a pound of cure” when you are planning your malaria prophylaxis.

The only vaccination required for entry into Ghana is the yellow fever vaccine. You must present proof of this vaccination before you can obtain a visa for Ghana. You also should carry the yellow immunization card with you, keeping it with your passport, as you may be asked to show this when going through customs at the airport in Accra. Check with your local health department about obtaining this vaccination. You should also ask about obtaining boosters for certain immunizations that you probably received in childhood, in particular polio and tetanus.

There are several other vaccinations that you should consider, especially if you will be in Ghana for more than a few weeks. Some of these require a series of shots so ask as early as possible. Highly recommended is the hepatitis A vaccine, for travel almost anywhere in the world. Also recommended are the vaccines for cholera and meningococcus. If you will be in Nalerigu for more than a month we recommend the hepatitis B and the rabies vaccines, and possibly boosters of certain other immunizations.

You must have an up-to-date passport with an entry visa for Ghana. Your travel agent can get this for you or you can contact the embassy of Ghana in Washington, D.C. but realize that it may take a few months so start early. This is very important: request a tourist visa. Visas are usually good for one month but can be extended once you arrive. For a little more money you can, after arrival in country, obtain a multiple-entry visa that’s good for a year in case you may be planning to come in and out of the country during that time.

Before you leave the U.S.A. you should talk with your accountant about which expenses of your volunteer service are deductible. Save receipts and keep good records because you are on your own for this. Make plans for an extension if you will not be able to file your tax return by April 15^th. If you have a choice, often the timing of a trip can make a difference in your taxes (volunteers staying a year or more, with earned income, have a definite tax advantage if they are gone for a complete tax year as opposed to portions of two different years).

If your regular medical insurance does not cover overseas travel (including medical evacuation for emergencies) you should contact the IMB for advice on overseas coverage (the Board makes available an inexpensive policy that does cover these things). Note that Medicare does not cover any overseas travel.

You may be contacted by some of our families about bringing some things to us. We try to encourage them to limit this to necessary or emergency items. Occasionally someone, including one of us on the field, may ask you to bring something that is less-than-essential, e.g., a video or CD or small food item. Whatever the item under discussion the rule is always to pack what you need and only then consider bringing something for someone else. This becomes more of an issue the longer you will be staying. You are under absolutely no obligation to carry anything other than your own personal items. If you are able to carry something extra, know that it will be extremely appreciated.

Be sure to check with your travel agent for particulars on luggage allowance including number of pieces, size, and weight they allow. Overweight charge on excess baggage is VERY expensive. Most airlines allow two checked bags per passenger at 70 pounds per bag. If you plan on stopping in Europe (or other sites) either coming or going, the allowance could drop to 20 kilograms (44 lb.), either per bag or even PER PERSON. Also note that most airlines have become rather stringent about criteria for carry-on items.

After you check in, check your luggage slips to be certain that your luggage has been tagged properly. Most of the time baggage arrives here safe and sound but NOT when the airline has tagged the bags incorrectly. Due to the change of planes in Europe and the possibility of late departures and/or arrivals, we strongly recommend that you pack enough in your carry-on bag for several days’ (maybe even one week’s) living, in case your suitcase doesn’t arrive until several days after you do (it may even arrive after you have departed for the north).

When packing any liquids we recommend that you double bag them in Zip-Loc-type bags so that they won’t leak if crushed. For other travel tips check out the following Website: www.bhg.com/travel/.

uREMEMBER TO KEEP ALL IMPORTANT PAPERS WITH YOU AT ALL TIMES, IN YOUR CARRY-ON AND NOT IN YOUR CHECKED LUGGAGEt

It will be hot in the airport! Stay calm and cool. Remember that the Lord is present with you everywhere even in the Kotoka International Airport.

Before leaving the plane you may be given a yellow disembarkation card to complete. Keep this handy with your passport, as you will need it later. You will also be told that NO PHOTOGRAPHS are to be taken at the airport or at any police or military installations. They are quite serious about this.

uOccasionally, upon entering the airport, young men who are not officials are there looking for a “tip” or “dash” from unwary travelers in exchange for “helping” you. Be confident, tell them that you know what to do, and steer clear of them. DO NOT GIVE YOUR PASSPORT OR OTHER PAPERS TO ANYONE BUT THE OFFICIALS BEHIND THE DESKS OR COUNTERS!t

The first stop is the Health Card (Yellow International Immunization record) check. The official there will check it and return it to you.

The next check point is immigration. There are several booths here, some marked ECOWAS (West African Nationals), Ghanaian Residents, and Other Nationals. Join the line of “Other Nationals” (as the lines at certain booths get short, you might be directed to join a line other than “Other Nationals”). The Immigration Officer will check your passport, recording information from the yellow disembarkation card in to your passport and stamping it. You may see others handing money to an official along with their passport trying to speed up the process. This is generally accepted practice but it is NOT LEGAL. The officials are all very polite and efficient and will do their work without this “dash” (tip).

After you pass through Immigration, right before collecting your luggage, you will see a Currency Declaration booth. The officials there might ask you how much foreign currency and Travelers’ Cheques you have, possibly even asking to see it. If they think it needs to be recorded (LARGE amounts do) they will give you a form to complete called a “Ghana Exchange Control Travel Form.” When exchanging dollars to cedis at an official foreign exchange shop you can have this form stamped, verifying your legal exchange of money. Occasionally you are asked to show this card upon exiting Ghana. REMEMBER that the ONLY legal exchange of money is through a recognized exchange shop. You are only allowed to bring up to US$5,000.00 into Ghana legally. When you have finished, a man will be at the doorway checking everyone’s papers. He checks to see that you have stopped at the various checkpoints by checking your passport and other paperwork.

In the main baggage area there are often men wanting to help you with your luggage. The official porters wear overalls. They will have carts and will assist you in collecting your bags and taking them through customs and out the door. The porter may suggest that you “give something to the customs official’ but this is certainly not necessary, may be illegal, and we don’t recommend it! Rarely do we have any problems with customs officials at the airport. They are ready and eager to have people visit Ghana and may even pass your bags through without opening them or charging any duty. We have at times, however, had to pay duty on some items. If you are bringing any medical supplies for the hospital and are questioned about this, tell the customs agent that the supplies are for Baptist Medical Centre in Nalerigu, in the Northern Region. The hospital’s reputation extends to many in Accra and this should clear the way for you (even medications should be allowed through without trouble, the only exception being narcotics, which you shouldn’t try to bring anyway).

After going through Customs, you will proceed with the porter (if you choose to use one) through some double doors to the outside. Just before, another man may check your bags against your baggage claim tickets. Then you will be finished!

When you arrive outside, there will be a LARGE crowd of people waiting for travelers. Keep your personal items well secured. Someone from our mission will meet you and help you get the bags to the car. They will tip the porters/carriers for you and you can reimburse them later (we want to discourage you from using US dollars for this). Be warned: if anyone meets you inside the airport claiming to be with the mission be polite but tell them that your party is meeting you outside and then proceed outside on your own. Do not give them any money, papers, or information about yourself.

If for some reason there is no one there to meet you (very rare), proceed as follows:

· If no one should answer, find a taxi, tip the porter no more than one dollar for all bags, and tell the taxi driver to take you to the Baptist mission (see below). Agree on a price with the taxi driver BEFORE you leave the airport (there is a rate schedule posted inside the airport to let you know how much to pay). If you are bringing a lot of baggage with you it’s possible that you may need two taxis.

· The hostel is located at No. 34 Josef Tito Avenue. It is near Flair Catering and near the residence of the Japanese Ambassador. It is only about a five-minute drive from the airport to the hostel (see map, page ).

Unless instructed otherwise (Nalerigu is an exception – see below), never drink any water, anywhere, unless it is bottled or you drink it in a missionary’s home so that you know it has been filtered. You can catch several types of bacterial or parasitic diseases, some quite severe or fatal, from unclean water; the least of these is intestinal upset associated with diarrhea that can be very uncomfortable or debilitating.

There are very few places in Ghana where tap water is safe. In most instances, water for drinking or food preparation should be filtered or boiled. One notable exception is in Nalerigu, where the tap water comes from wells or treated cisterns. Some of the missionaries in Nalerigu use the filter for all drinking water and several do not, drinking directly from the faucet with no ill effects. We leave the choice up to you.

Most of us feel that all foods eaten raw should be soaked in a bleach solution for 20 minutes prior to being eaten. Use a capful of bleach to 1 gallon of water. Remove any visible dirt before soaking.

Do not come expecting to get sick. Likewise, you should not do away with all caution and just expect God to take care of you. We feel that God gave us brains for a reason and one should take reasonable precautions. We pray for good health but we do all in our power to take care of ourselves. Except for an occasional bout of diarrhea or malaria, most of our volunteers stay healthy.

In most instances satisfactory medical care is available in Ghana, and your hosts will be able to help you if you develop a medical problem. Medical care in government hospitals varies from time to time, depending upon the doctor(s) located there. There are a large number of very capable Ghanaian doctors who run private clinics (note that this applies only to whatever time you spend in the cities; while you are in Nalerigu you will be cared for by the missionary doctors).

BRING WITH YOU a supply of any medication you usually take, whether prescription or over-the-counter (OTC). Most pharmacies in Ghana are well stocked with basic drugs at reasonable cost but if you want to be sure that you have it, bring it with you. Some OTC medications to consider bringing with you: antihistamines; pain/headache medicine; antifungal (for athlete’s foot); something for vaginal yeast infections (due to the very humid climate during rainy season).

Because of climate and exposure to various diseases, be sure to have a nourishing diet at all times. It may be advisable to take a vitamin supplement. If you need a sugar or salt substitute, BRING IT.

Airmail comes fairly regularly and typically takes 21 days to reach Nalerigu. There can be a delay of an additional one to two weeks or even more, depending upon the mood of those involved in handling the mail (it’s carried on public transportation). There are two ways to send packages: airmail and surface mail. Airmail is very expensive but does arrive much more quickly (the same as letters). Surface mail is much, much cheaper but typically takes three to four months, sometimes six. Either way the recipient may have to pay customs to collect the package, which can sometimes be expensive. The best way to reduce customs charges: try to have only used items sent to you; have the item(s) labeled as “gift”; if you must mark a value on the contents, mark as low a value as is honestly possible.

Another option, if someone stateside is bound and determined to send you something while you’re in Nalerigu, is to have it sent with another person coming from the U.S. (another volunteer or a missionary returning from stateside assignment), noting that the same guidelines apply here as did to you in “BEFORE YOU COME, section I. above.

Your mailing address while in Nalerigu will be as follows: [your name], Baptist Medical Centre, P.O. Box 50, Nalerigu via Gambaga N/R, Ghana, West Africa. The aerogrammes available from the Post Office work very well and are a cheap way to write letters in either direction, although you cannot send any enclosures. If you will be here for more than several weeks, bring some U.S. stamps with you so that you can send back letters if anyone from here is returning to the U.S.

Baptist Medical Centre has a satellite telephone, used for both standard phone service and e-mail messaging. Usage rates in the past have been about $3/minute for outgoing calls. What most of us do is either have family in the U.S. (or wherever) call us at a pre-arranged time and date or call your family and tell them to call you back immediately. It costs you nothing to receive a call; the cost to the one calling varies, depending upon that party’s long distance carrier (we’ve been told it ranges from 96¢ to $10.00 per minute).

E-mail charges are essentially the same; the problem is that there is a slow transmission rate on our equipment, resulting in e-mail charges (for sending and receiving) of about $2-3 per message. Be sure to notify your family and friends of this. Most critical is to tell them to send NO attachments of any kind. It can literally take hours to download messages with photo, video, or other types of memory-intensive attachments. We have no way of see what messages are waiting for us until after we download them, so if something like this gets sent a HUGE e-mail bill will result for you.

Due to weather conditions and other factors, the satellite phone is not always available. Another option is to use the public phone in Gambaga, a 10-minute drive from Nalerigu. Using prepaid calling cards, calls from this phone are usually about $1.45/minute. The caveat: as often as not this phone is out of order.

Further south (Tamale, Kumasi, Accra) you are able to use AT&T and Sprint calling cards. If you make calls from the hostel in Accra you can dial direct and just pay the hostel staff when you settle your bill for room and board.

The current in Ghana is 220 volts, 50 cycles; in the U.S. the current is 110/120 volts, 60 cycles. All houses on the BMC compound, and most of our guest houses in other cities, are wired for both 110 and 220 volts but both are 50 cycles. This makes a difference only for devices that have an electric clock mechanism; more specifically, an alarm clock that plugs into the wall will not keep correct time. You should bring with you a battery-powered (or wind-up) alarm clock. Also be advised that we are now on the national power grid and the power goes off, on the average, about once a day; sometimes for a few minutes, sometimes longer (in which case we turn on our back-up generators). If you want to bring a computer, we strongly recommend that you bring a laptop with a good battery and a surge protector.

You can get money exchanged in Accra and other major cities. You get a better exchange rate with cash, especially large bills like $50.00 and $100.00. You can get a cash advance on a credit card at certain large hotels but will need your passport with you to do this. Travelers cheques can also be exchanged but at a slightly lower rate. What many of our visitors choose to do is to write a personal check to our business facilitator in Accra and she will give you Ghanaian money in exchange.

The local unit of currency is the cedi (SEE-dee) and a dollar will buy an awful lot of them. However, as there are no large cedi notes, most purchases in the south involve handling larges amount of cash. For example, when you buy groceries you can easily spend ¢400,000 plus you’ll need money to eat out, buy a nice Ghanaian shirt or dress, fill your tank, etc. We suggest that you bring a fanny pack that has a sizable interior compartment; say, one that could accommodate a stack of notes the size of a brick.

Note that credit cards have limited usefulness here, even in the cities. The nicer hotels and restaurants will accept them but that’s about it. Nowhere north of Kumasi is a credit card good for anything except conversations. It’s okay to bring one, just don’t count on being able to use it.

If you will be here for several months or more, be sure that there is a family member at home who has agreed to keep up with your bank account and has the authority to withdraw money in case of an emergency.

The economy of Ghana is stable and gradually improving, which means that there is an increasing variety of foods available in the cities. Most prices are reasonable or even cheap but some can be quite expensive, sometimes twice or three times what you would pay in the U.S. The following should give you a rough idea of what’s available here:

· Dry goods: beans and black-eye peas, rice, sugar, flour (mostly white), pastas, oats

· Canned foods: tuna, hot dogs, salmon, Spam, vegetables (these can be expensive)

· Fresh produce: a good selection is available in most cities, like cabbage, cucumbers, carrots, onion, potatoes, green onions, green beans, tomatoes, bananas (including plantain), pineapples, mangos; green peppers, various squash, and apples can often be found. Lettuce is somewhat rare and usually bitter. Cauliflower and broccoli can be rather expensive and some items like grapes ($5/pound) can be outrageous. The selection in Nalerigu is less varied and more seasonal.

· Eggs tend to be plentiful, even in the north. Meat is somewhat expensive but almost always of a low-fat nature (you’ll have to add oil to your pan to cook the hamburger meat here!).

· Milk is available as powdered (usually full-cream, though occasionally skim) or non-refrigerated liquid (has been irradiated so it has a long shelf life unopened). Fresh milk (i.e., liquid that must be kept refrigerated) is available only in the cities and only in 1 liter or smaller containers. Note that the powdered milk in Ghana is better quality than that in the U.S.

· Snack foods are increasingly available: pretzels, chips, candy bars, popcorn.

· The peanut butter (called groundnut paste) found here is of the “natural” variety seen in the U.S.; i.e., it’s just ground peanuts, no salt added. The oil separates after a few days of shelf life but is easily stirred back into the paste. Very tasty!

One category noticeably absent here is seasoning packets. Also, the variety of spices and seasonings often found in the U.S. is not here, although you will find certain ethnic seasonings in great quantity. Also absent are sour cream (can be made with local ingredients) and cottage cheese. Sometimes we find cream cheese.

You will spend at least one night at the hostel after your arrival (virtually all flights arrive and depart in the evening; Ghana Airways may be an exception) and most likely one night before your departure; see rates below. Currently the only way to get from Accra to Nalerigu is overland; the flights from Accra to Tamale have been indefinitely suspended. There will be a $180.00 charge per vehicle (i.e., if there’s two people in your party, the $180.00 is divided two ways, etc.) to get you to BMC and then back to the hostel when you’re ready to leave. This trip is a 13-hour drive one way and the last hour before you get to BMC is extremely rough road; because of this we usually try to make the trip in two days each way. If your schedule is very tight it can be done in one day but be warned that a drive this long added to jet lag will leave you very tired.

You will be billed for your stay; the current rate is $5 per person per night; this applies to any of our guesthouses (i.e., the hostel in Accra, the guesthouse in Kumasi or Tamale, one of the guesthouses in Nalerigu). Should you choose to have your meals prepared for you at the hostel, you will be billed $4 per person per meal; family rates are usually available. Air conditioning is available in certain guesthouses (not in Nalerigu) at the current rate of $0.75 per hour. Laundry can be done at the hostel for $1.50/load.

While in Nalerigu you may have a choice about your housing: either staying in the home of a missionary/couple, taking your meals with them, etc. or having a house to yourself (or shared with another volunteer if you come as a team). We cannot guarantee that you will always have this choice but if you have a preference please let us know and we’ll do our best.

Some of our visitors choose to have someone help them in their home with cooking or housekeeping. If interested, please inquire about the availability of this during your particular stay. Likewise, we can offer advice about how much to pay, etc.

We will do our best to make sure that your accommodation is clean and neat when you arrive and would ask that you leave it just as clean and tidy when you leave.

With the exception of two or three “cool” months (temperatures as low as 70°F/21° C at night) it is hot all the time, sometimes very hot. Bring lightweight, washable clothing that you would wear in the summertime in America. Most people wear cotton, cotton blends, and wash-and-wear trousers, shirts, blouses, skirts, and dresses. Clothing here soils more quickly from perspiration and general conditions and requires frequent washing. The sun fades clothing quickly and the humid climate can be hard on clothes. Dress is more casual here and a necktie is never worn. Note that the soil in the north is a red clay blend; the stain can be difficult to remove.

Sandals are usually worn in the daytime, even to the hospital. We recommend that you bring one good pair of enclosed shoes, either for night wear to and from the hospital or for hiking at the Nakpanduri escarpment (one of the few “things to do” in the north). Rarely, if ever, are pantyhose worn.

Missionary women wear slacks and modest length shorts only inside one’s own home and when visiting another missionary’s home. Few African ladies wear them, especially in the north. Plan to wear dresses or skirts and blouses when working with the African community. Ladies, bring cotton underwear, including some half-slips; full length ones are too hot! Men usually wear sport shirts and lightweight trousers. We suggest you avoid double knits, knits, and Dacron and nylon blends, as these are not suitable for the heat of the tropics.

You might have occasion to swim at a private hotel pool or on the beach; one suit should be sufficient. If you are a jogger or runner, running shorts are acceptable for this sport, even for the ladies (if not too revealing). There is a tennis court and one of our current couples plays regularly.

See section J under “When You Arrive” above for the foods that are readily available in Ghana. According to your own personal preferences, here are some items to consider bringing: seasoning mixes (as for spaghetti, taco, stir fry, etc.), snack foods (especially microwave foods), Kool-Aid (unsweetened – sugar is readily available), salad dressing mixes. Several brands of good quality tea are available but not much selection of coffee; bring your own if you’re picky. If you will be doing a good bit of cooking, consider cinnamon, Italian seasoning, maple flavoring, and Dream Whip. Butter and margarine are available; Crisco is available but is hideously expensive.

Quick mixes are not found here, so some of those are nice to have: dry soup mixes, cake, cookie, muffins, brownies, etc.

The availability of cosmetics and personal hygiene products is changing, with more becoming available but the cost varying. The deodorant, shampoo, conditioner, and skin lotions found in Ghana seem to be of generally good quality and the cost reasonable. Razor and replacement blades are quite expensive; little shaving cream is found but what there is seems of good quality. Bar soap is plentiful and seems mild to the skin; we use it regularly. Toothbrushes, toothpaste, and body powder are also available. We suggest you bring a good supply of personal cosmetics, as you may well not find what you need. Sunscreen is a must, as Nalerigu is just barely above 10° north latitude, meaning the sun is almost directly overheard and you will burn very quickly, even on cloudy days. We suggest using a total block, something with an SPF of 15 or higher. As mentioned above, you will need an ample supply of insect repellent, something with a DEET concentration of 20 – 35 %.

A supply of facial tissues in the little handy travel packs is very useful, although good tissues can be purchased in the cities; likewise, toilet paper can be bought here (in the south, in the cities, before you come to Nalerigu). Consider also some “handy-wipes” and/or a bottle of the hand sanitizer now found in most stores. If you will be here during the dry season, bring some Vaseline or Chapsticks for your lips.

Depending on your assignment, you may need to bring supplies to aid in your work. Short-tem volunteers should come equipped and ready to work since there is often not enough time after arrival to gather supplies. For office workers, it would bring you peace of mind to bring a small divided plastic box with pins, tacks, rubber bands, paper clips, and other office supplies. You might want to include a few magic markers and a roll of twisty ties.

If you are a musician, consider bringing your instrument of choice, if this is feasible. Ghanaians love music; you will make many friend with this and it can aid in ministry opportunities.

A flashlight is a must; either bring extra batteries with you or purchase them in Accra as there are no good batteries available in Nalerigu or nearby. A pocketknife can also be useful.

Many of our visitors bring a camera. Keep in mind the rules about what to not photograph (see When You Arrive, section A, “Arrival in Ghana at the Airport” above). The availability of film varies – probably best to bring your own. Certainly you will need to bring replacement batteries for your camera.

In spite of what the locals may tell you, it is not the usual practice to pay someone for taking their picture. If they tell you this, just laugh as though they are making a joke (the reality is that they aren’t truly expecting to get any money but they figure it never hurts to ask). We do usually ask permission before we photograph someone and almost no one refuses. Sometimes your subject may ask you to send them a copy of the photo. We ask that you be noncommittal about this as it is very difficult for us to deliver these photos; we just don’t have the time to track down the subjects and most don’t have a mailing address.

Prints can be developed in the cities, usually with a one to two day turn-around. Slides cannot be developed here yet, nor can the APS rolls of film or the “throw-away” types of cameras.

Consider bringing with you a one or two-quart thermos/cooler to keep water with you at the hospital or out in the village. There are no drinking fountains at the hospital and during the hot season the tap water can be very warm.

We recommend that you carry a small sewing kit. While in Nalerigu, of course, one of the missionaries would assist you with any needed repairs but en route you would need your own supplies. Also, you may want to bring writing supplies for letters: occasionally someone may be returning to the U.S. before you and could post a letter upon arrival. Most writing supplies can be purchased cheaply in Ghana but you would, of course, need to bring U.S. postage stamps. Letters mailed from Nalerigu take 14 – 21 days to reach the U.S.

If this will be your first trip to Ghana to practice medicine, you must register with the government. You must send in certain items (see below) to initiate the registration process and we suggest that you do this as early as possible, as sometimes the medical council doesn’t meet on schedule. You must also appear in person at the registration office. Because of this we recommend that you arrive on a Saturday or Sunday – Saturday if your schedule would allow you to use Sunday strictly for rest (not a bad idea – see Before You Come, section A “Scheduling Your Travel” above), Sunday if your schedule is tighter. Either way, you would appear at the registration office on Monday morning, then proceed with grocery shopping or just head on up north. You can, of course, arrive on other days of the week as needed (the worst is Friday: terrible crowds at the airport and you would have two days to wait for going to the registration office).

For work at the hospital, we suggest that you bring the following equipment: stethoscope, diagnostic kit (we do have an ample supply of disposable otoscope cannulae), penlight, calculator, and extra pens/pen refills (you will do a lot of writing at BMC). It would also help if you could bring exam gloves. Your white coat is not necessary as we have several that you can use; due to the heat, though, we never wear them except over our scrubs between cases. As you won’t be wearing a white coat on rounds and therefore won’t have those nice roomy pockets for carrying doctor stuff, consider bringing some sort of bag in which to carry your stuff while on rounds and to the clinic. A clipboard is also handy.

Leave your neckties at home. We wear simple slacks and shirts at the hospital (dresses or skirts for the ladies, please); we do not wear scrubs to the clinic, not even if you bring your own. Sandals are perfectly fine at the hospital. Many like to bring a Thermos/cooler of cold water to the hospital each day.

If you will be operating, it’s best to bring your own surgical gloves. Note that we cannot provide enough gloves for you to double-glove; if you feel that you must do this then you definitely need to bring your own supply (see the comments about AIDS below). We provide scrubs, masks, and head covers (non-disposable) but not booties; either bring your own supply of booties or (as we do) some sort of footwear that can tolerate being filthy (rubber clogs, galoshes, etc.). We would recommend not using an old pair of tennis shoes as things often get very messy during cases and you wouldn’t want to have to untie filthy shoelaces.

We would appreciate any items collected from your office or local hospital for our use here (i.e., items that are clean though not sterile but still usable, like a Foley catheter that is out of its wrapper but not used). We can use virtually all types of bandage/dressing materials, hypodermic needles, suture (see list below), Foleys catheters, NG tubes, Q-tips, chest tubes, and urine collection bags. Stoma bags and related materials would be extremely useful, as would ligation clips (medium and large) and GI staplers, especially the EEA type. We are unable to use most of the high tech stuff: laparoscopy-related equipment (except staplers and clip appliers, which we can use), central venous catheters, etc.

Bringing donated medications is greatly appreciated but we currently cannot use expired medications nor partially used topicals or injectables. We cannot use all donated medicines (e.g., cannot use cholesterol-lowering meds) so if possible, please check with us before you come to see if we are able to use what you have.

AIDS: Thankfully, AIDS is not a major problem in Ghana, unlike certain other African nations (see the February 2001 issue of Time magazine). An exact incidence rate is difficult to determine; the government’s Ministry of Health cannot afford to provide enough HIV testing kits to determine this information. We are currently seeing between 200 and 300 AIDS patients each year (out of an average of about 30,000 individual patients seen annually). We do have enough testing kits so that you may test any patient that you suspect of having AIDS.

Immediately upon your arrival, if you are not given a copy of the Medical Volunteer Handbook, ask for one. This booklet will describe how we do things at Baptist Medical Centre, how to handle certain situations, local customs (e.g., you do not inform a patient that he/she has a terminal illness), etc. If you think it would be helpful to you to read over it in advance, ask and we will try to get one to you.

The Christian Medical & Dental Societies offers the “Mission Survival Kit” for those interested in short term (or even long term) missions. Although I have not examined this item myself, I do know that the CMDS are very experienced in international missions, having sponsored numerous trips over the years; I would anticipate the kit to be a valuable resource, though there may be some overlap of the material given in this handbook. Its contents include (I’m quoting from the advertising flyer): 4 audio cassette tapes, Answers to All Your Questions, How to Get There and Back Safely, Crucial Cross Culture Communication, Successful Spiritual Ministry, Maximizing medical/Dental Outreach, Personal Packing List, Information on Insect Bites and Malaria, Short-Term Mission Organizations, and Sources for Medicine and Supplies. It retails for $24.95 ($19.95 for career missionaries) plus shipping and sales tax. To order: by phone = 1-888-231-2637; fax = (423) 844-1005; e-mail = main@cmdsmail.org; Web = www.cmds.org

(The following was written by Ken Roundhill, KGK Associate Staff, Kyoto, Japan, and appeared in the March 17, 1982 issue of “Together.”)

1. Don’t go abroad believing yourself to be a fourth member of the Holy Trinity; a missionary is “one beggar showing another beggar where to find bread; that is all.”

2. Don’t expect a welcome. You are being “sent,” not invited! If you have been invited, it may be for other reasons than the gospel. The cross is a reproach, not an attraction. You will have to earn the right to people’s affection and trust; then you will be begged to return, though you won’t need that encouragement.

3. Don’t expect to win their respect, their hearing, and their hearts without doing them the honor of learning their language, and, with it, their culture.

4. Don’t leave home unless you intend to see nationals take over your work as soon as possible and yourself working under them in a supportive role.

5. Don’t be a loner. The solitary Christian is a contradiction terms. The solitary missionary is a menace to himself and a plaything of the devil. Make sure a band of God’s people (as many as you can enlist) is determined to pray for you regularly. When you arrive, make haste to be surrounded by Christians of the same type. Ask for prayer from the simplest of believers.

6. Unpack your suitcase, then hide it and forget it! Some missionaries never really unpack.

7. Practice patience. Note that this is the first of the great Apostolic signs (2 Cor. 12:12). You will need patience for language study, to understand the veteran missionary, acquire new sleeping habits, unmen-tionable smells, unpalatable food, incredible, insects, intolerable noise, unbelievably dull hearers, slow mail, interminable “red tape,” and, worst of all, learning about a self you never knew you were!

8. Ask God for the special help of two people. First, a veteran expatriate missionary who will show you what not to do. You can profit from others’ mistakes. Second, a greatly used national leader who will show you what to do even though he or she knows that you can’t.

9. Keep open the lines of communication. Write personal letters not just to givers but to pray-ers, also, and feed their prayers.

10. Be yourself! You have the body, abilities, temperament, and face that the Lord meant you to have. Don’t be slave to some image of what you think a missionary ought to be. Relax in Christ. Find your own com-pleteness in Him alone. Your contribution as a missionary will be quite unique to yourself. All you have to do is please Him.

TRAVEL EXPECTANTLY: Every place you visit is like a surprise package to be opened. Untie the strings with an expectation of high adventure.

TRAVEL HUMBLY: Visit people and places with reverence and respect for their way of life.

TRAVEL WITH CURIOSITY: It is not how far you go but how deeply you go that mines the gold of experience.