Thursday, December 01, 2005

Gin & Logic

Spent Friday “out in the field,” as we glamorous foreign corro types say, learning first-hand about the difference between Canadians and Africans.

There is an old and actually not-so-funny joke that perfectly sums up Canadians:

“How do you get 50 Canadians out of a pool?”
“Get out of the pool, please.”

We will do virtually anything we’re told, usually without question. We’re the most accommodating of people, the type who don’t want to offend, don’t want to cause trouble or create a ruckus. We’re meek, quiet, more likely to speak our minds through sarcasm than blunt truth. We’ll put up with the worst, make do rather than make a fuss. There is little we do without quiet reflection and if we’re going to argue, it’s more likely to take the form of polite debate.

Africans, on the other hand…

It’s the frequent topic of conversation amongst weather-beaten NGO workers, who arrive with the best of intentions, shiny with their expectations and promise, laden with answers and solutions. For the most part, they promptly find themselves beaten down by a logic that is really not comprehensible for Western minds. Then, sufficiently soused with gin and tonics, weary from round-and-round conversations that involve solving the world’s woes, they roll this particular African logic around in their brains, trying to make sense of what happened to their perfect solutions, their easy answers, their reinvention of the wheel.

These conversations invariably begin with: “What they should do is…”

If only it were that simple.

Think of the problems that plague Africa. The plagues, for instance. Immunization. Education. Poverty. All have undoubtedly been solved on paper a million times over, even in conversations that get rather cloudy as the night wears on and the booze runs dry. The questions that are asked with a shake of the head: why won’t people get polio vaccines? Why won’t men wear condoms? Why don’t microcredit loans work? How do African women bear to get up in the morning? Why are their husbands such lazy louts? Why do people put up with ineffective dictators? Why doesn’t anyone stand up to corruption?

Why, for example, does Ghana still not produce iodized salt, almost a century after scientists first discovered not only the impacts of iodine deficiency – mental retardation, serious birth defects, stillbirth, miscarriage, lowered IQs, stunted growth, decreased productivity – but that the easiest way to get it is by sprinkling potassium iodate on salt in a processing that actually improves the product?

Why, not only in the face of the all the medical evidence, but after study upon study has shown that Ghana is losing millions in export potential by not iodizing its salt? Why can it not get its act together?

The answer is complex. And frustrating. And uniquely African.

So break out the gin.

The day begins at 9.30 a.m., but doesn’t really get underway until about 10 a.m. This is African time and Rebecca, the Unicef Salt Iodization Officer, did tell me “We’ll get going by 10 a.m. at the latest,” which is a rather strange way of answering what time she’d like me to show up. We drive through Accra’s dirty, crowded streets, so plugged with traffic it takes more than an hour just to make it to the outreaches of the city and we nearly plow into the side/back/front of at least three cars. (We are in a Land Rover, this being Unicef, and I know that in Africa nothing ever happens to the indestructible NGOmobile and have signed a waiver saying that I will not sue if maimed or otherwise injured. My brother, however, will take Unicef for all its worth.)

We wind our way to Nyanyano, where Deg Heyward-Mills is at this moment turning water into wine under a circus tent pitched up in a field, as part of his “Jesus Healing Crusade.” I would really like to be in that tent, maybe acting as the Water-Into-Wine Verification Officer, but instead I’m sitting on a lawnchair outside of the Nyanyano salt producers co-op office, a shed of a building where three or four members are telling Rebecca that their problem is that they don’t know the calibration of the backpack sprayers and they would like some more potassium iodate for free and they would also like her to do more marketing for them.

She is a food technician, a young little thing who takes no guff from anybody. I like her immediately. She’s got one of those senses of humour, where everything she says is deadpan, but everyone around her is laughing. Except me, as she’s speaking for the most part in Fanti and I can’t understand her.

We go on a tour of the salt ponds, the dozens and dozens, hundreds upon hundreds of 3-inch concrete pools filled with water pumped up from the nearby lagoon. I instantly regret wearing a skirt, but laundry has limited my options. Rebecca chuffs at the sight of all of these ponds. She explains, patiently and with humour, that if only the co-op would convince its members to get along, to raze their operation and start over, co-operatively, with wider, deeper ponds, they could get three times the salt with half the effort. (SEE STORY BELOW)

The men just shake their heads and smile. No one here gets along. There are land ownership issues, long standing feuds, inheritance issues that remain unresolved. No one will ever agree to that.

But the pumping, Rebecca says. That just adds to the farmer’s costs. The men shake their heads again. They know all this. They’re not stupid. They’ve been pulling salt from their ponds for a long, long time. The chairman is their shining example and they hope through him they’ll be able to convince their membership. He has massive ponds, twice the size of the ones around him, and they’re deeper than the others. He pumps, but less often. And he gets three times the yield.

Still, the men shake their heads. It will be a long, long time before anyone admits to seeing the wisdom of the chairman’s ways and follows in his footsteps.

When we get to what turns out to the halfway point, I ask the question that’s lingering over this tour: How many of these producers iodate their salt?

Again with the head shaking. The farmers think it’s too expensive, the men say. They don’t understand the benefits. They don’t see the damage that iodine deficiency causes. (That’s because they eat a lot of shellfish, which haz natural iodine, Rebecca tells me, and its unlikely anyone in this village would know a goiter if it walked up and nodded at them like a second head). They don’t care that it’s law. They don’t want to pay for potassium iodate and no one is going to make them.

They need more education, the men say. Rebecca merely looks away. She knows they could educate them until they hold a PhD in potassium iodate; it doesn’t make the chemical any cheaper, nor does it change the fact that salt has produced this way for hundreds of years, nor does it refute the argument that “our forefathers” ate non-iodized salt and they lived to be 83. On average.

The men treat us to lunch. Rebecca tries again to understand why this co-op isn’t acting co-operatively. There’s more talk about the cost of the potassium iodate. It’s six million cedis for a huge drum. That’s about $800, which is serious coin. But this is a coop with more than 200 members and it only takes a teaspoon to iodate 10 kg of salt. That huge drum will iodize 300,000 kilos of salt. (Enough for a bad Winnipeg winter, I’m willing to bet.)

We drive to the Kasoa market, where the market ladies have been waging a war with the road repairmen for more than a year. The roads are being upgraded and in preparation for the construction of wider, smoother lanes, a brand new market was built on the edge of town, with smooth concrete floors, tin roofs, even shelves inside each stall. The thing sprawls on and on, and women sell everything from pigs feet to garden eggs to lacy underwear, tiny bunches of indigo dye, hair extensions, hair baubles and sachets of salt.

The women used to sell right next to the road, their pineapples and plastic sandals occasionally spilling over onto the street. So the enforcement people come and kick them out, tell them to go to the new market or they’ll be squished under the Caterpillar trucks. And every day the market ladies go out, the same as always, shouting and gesturing and tossing their big stomachs and floppy breasts around, screaming themselves hoarse, until the construction men just back off, go home, try again the next day.

Anyway. At the Kasoa market, Rebecca and I walk to what feels like the very back, but is probably only the middle of the market and she takes out of her purse three droppers of chemicals and a little silver pick. She sidles up to the first woman, explains what she’s doing, then gouges into one of her big 50 kg bags of salt with the pick, extracts some salt and douses it with chemicals. It should turn deep violet, but nothing happens. After six bags, Rebecca gives up. None of these women are selling iodized salt.

They tell her the producers make them buy the potassium iodate and only then will they sprinkle it onto their product. These ladies, who are all sweetness and smiles to Rebecca, are actually cunning, ruthless, conniving foxes. You should never mess with a market lady, because she will get you. They’re so much smarter than anyone else and they’re devious too. But they look like angels and it’s hard to stay mad. They are buying all their salt on credit, taking weeks to pay off their debts, starving the farmers and contributing to their inability to pay for the potassium iodate. It’s all a game and, so far, the market ladies are winning because they know it’s the producers’ responsibility to iodate the salt.

We drive back toward the city and stop at the police barrier. There are few cars that pull over willingly at a police barrier, but Unicef handed out 58 test kits so that the officers could test salt being distributed across the country to ensure that it had been properly iodized. There is a law – has been for nearly a decade – that says no one can sell iodized salt. It’s punishable by a year in prison or a 5 million cedi fine. (The government-owned salt factory, however, only began iodizing its salt a year ago and it uses such an antiquated process no one believes that the salt is being “properly” iodized.)

So here are police that are always hungry for handouts, that are so audacious in their corruption that they will actually say to drivers dumb enough to roll down their windows “Do you think it’s possible?” and wait for the customary bribe. They come up with spurious accusations (“Your child is under the age of 10 and cannot ride in the front seat”) and ridiculous allegations (“One of your headlights is too bright”) all in an effort to skim a little from the hapless driver.

So here is a chance – a legitimate one at that – to catch people doing something that’s actually illegal. But when Rebecca gets out of the Land Rover, obruni in tow, the inspector looks at her blankly. He has no idea what she’s talking about. Headquarters has not told them to do this, he tells her, so they can’t do it until headquarters says they should.

(While we are having this conversation, I watch one young cadet palm bribes from three different tro-tros. I feel like asking, “Are we in Nigeria?” but figure my Canadian sarcasm will not be appreciated.)

I tell Rebecca I would like to see some of the market ladies arrested. She agrees, but I really mean it. I’d like to be there when someone puts cuffs on one of those big, loud ladies and hauls them back to the ridiculously tiny blue Citroens the police drive here. (I have been overcharged for tomatoes one time too many.) But arresting these ladies is the easiest way to make sure the iodization process is actually followed. They’ll demand it. The producers won’t be able to squirm away from it. No one beats a market lady.

We have one more stop to make, at Mina Chemicals, where the president is a very proud Lion and a smart, articulate man to boot. Rebecca wants to know what he’s selling his potassium iodate for and is actually there to make the case that he should be getting a tax exemption. He regards her with suspicion, largely because he sees Unicef as a competitor in the chemical provision business, as they sometimes give out the iodate for free in an effort to entice producers to actually use it. It comes out that the Lion is paying nearly 25 per cent in taxes (ouch!) and he’s happily passing that on to customers. A tax break would be very welcome. He even invites Rebecca to join the Lions.

It has been a long day and my head is actually starting to hurt from what I’ve seen. Excuses everywhere. Ignorance. A blatant disregard for the greater good. A stubbornness that seems to border on the supernatural. And of course, the ubiquitous poverty that is frankly so ubiquitous one becomes inured to it.

Mr. Lion sums up the whole situation perfectly. “People will only do what you inspect, not what you expect.”

Ain’t that the truth.

News
Producers prodded to iodize their salt; ignoring RISK Ghanaians loath to add 'medicine' that would be good for health and economy.
Karen Palmer
SPECIAL TO THE STAR
1126 words
12 March 2006
The Toronto Star
A14

Rebecca Ahun dumps the damp mound of salt on to the dirt floor of the bustling outdoor Kasoa market, amid the dried fish and reeking pigs' trotters, exasperated by the faint blue hue of the crystals.

"That's not enough," she says in English before delivering a short lecture in the local Fanti language on the importance of selling salt fortified with iodine.

Ahun had been hoping to see the salt take on a deep violet tone when doused with testing chemicals.

But not one of the six 50-kilogram bags tested has been rinsed in potassium iodate.

Iodine has been added to table salt in most parts of the world since the early 1920s, but Ghana is still struggling to convince producers and consumers alike of the importance of iodized salt.

Despite an intense education campaign by UNICEF, funding and studies by the Ottawa-based Micronutrient Initiative and the special support of Ghana's president, iodized-salt consumption rates are actually declining, leading to more incidents of goiter, mental retardation and stillbirths.

The medical evidence is clear and studies show the country's non-iodized salt is costing millions in export potential, yet Ghana has no chance of reaching its goal of 90 per cent iodization.

As anyone who's ever preached the virtues of safe sex or the value of polio vaccinations can attest, nothing is ever as simple as it seems on a continent where communication is poor, education is low, poverty is rampant, enforcement is weak and stubbornness trumps most reasonable arguments.

"We have a lot of work to do," Ahun sighs.

Salt is one of the Earth's most basic substances, a crystal ionic bond found in both deserts and oceans. Its essence has flavoured foods since prehistoric times and its trade routes shaped the geopolitical landscape of the planet.

In the 1920s, iodized table salt was introduced to ward off thyroid diseases and other maladies caused by iodine deficiencies in the diets of people who weren't getting the recommended 225-microgram daily dosage naturally from sea salt or seafood.

In most countries, laws were enacted requiring table-salt manufacturers to add iodine and consumers demanded that it be supplied at no additional cost.

"Most everyone takes iodized salt without even realizing it," says Ahun, a biochemistry food technician who inspects salt for UNICEF, thanks to a grant from the Micronutrient Initiative.

Studies have shown that iodine-deficient children are less productive, have less energy, can have stunted growth and often have IQ scores 10 to 15 per cent lower than children who get the recommended dosage.

Women who don't get enough iodine have also been shown to be more prone to miscarriages and stillbirths, and they are more likely to deliver mentally challenged children.

About 70 per cent of table salt consumed in West Africa is iodized, but that's skewed by the figures for the most-populous nation, Nigeria, where consumption rates hover at better than 95 per cent, largely because it imports virtually all its salt from Brazil.

In Ghana, by contrast, consumption rates have dipped in the last two years to 44 per cent.

About 70 per cent of the table salt produced in Ghana is exported to nearby countries - including Benin, Burkina Faso, Togo and Ivory Coast - making its lack of iodine an issue for the region as a whole.

At a meeting two years ago in Senegal, the region's other major salt-producing country, researchers presented surveys showing that West Africans know the value of using iodized salt but still aren't using it.

"There's a missing link somewhere and people were pointing to the supply," Ahun says.

"The availability just isn't there."

A 2003 market survey found that less than 20 per cent of the salt available in the country had been iodized, although selling non-iodized salt has been punishable by up to a year in prison or a $700 fine for nearly a decade.

The problem, Ahun says, is monitoring the thousands of artisanal producers who ring the coastline, harvesting a bag or two at a time but adding up to a major part of the market.

At the salt ponds of Nyanyano, more than 200 salt farmers use pumps to fill concrete ponds with the local water, which bubbles up so salty it's undrinkable and takes only five days to produce frost-like patterns of harvestable salt.

Harry Quartey, secretary of the village's salt producers' co-operative, shakes his head when asked if everyone in the co-op sprays their salt with iodine before selling it in 50-kilogram bags to market vendors.

"They think it is some form of medicine, medicine, medicine, so they are always trying to avoid medicine," Quartey says.

Each year, UNICEF says, 120,000 Ghanaian children are born with some kind of mental retardation as a direct consequence of their mothers' iodine deficiency and about 15,600 are so severely disabled they require medical support.

A 1998 survey found a 68 per cent prevalence rate for goiter in children and women in the northeastern region of Ghana.

UNICEF research also suggests Ghana loses $22 million in worker productivity to iodine deficiency every year and estimates that $1.2 billion in wages will be lost in the next nine years.

UNICEF officer Tamar Schroeder also argues that adding iodine makes the table salt more exportable, not only because most countries demand it, but also because the extra refining improves the quality of the salt.

"It's not only important for Ghana for health, but it could be big business in Ghana - and that's why it's so important," she says.

Experts say the problem is easily solved, as Guinea proved in 1993, when a crackdown brought consumption rates up from zero to 68 per cent, while goiter rates dropped from 64 to 27 per cent.

However, when Ahun stops at a police checkpoint to see whether the officers are using UNICEF-supplied test kits to determine if bags of salt moving through the area contain iodine, the inspector stares at her blankly. He has no idea what she's talking about.

"We have a lot of work to do," she sighs again.

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