The costs of life.

In the United States, we live each day in a culture of consumption.  Messages coming from all directions tell us that if we are to be happy, popular, successful, valuable, we must buy and consume more and more things.  And we have done exactly that.  But because the numbers of things we desire and are told that we need in our lives are virtually endless, and our incomes are not, many of us-- perhaps most of us, I fear-- have found ourselves drowning and dying in debt.  This debt creates in us a great deal of stress and anxiety that negatively affects our health, happiness and the quality of the relationships we have with those around us.  Life does not have to be this way.

One of the things I love most about living in Africa is the simplicity of life here and the extremely low cost of living.  Comparing the cost of living in the United States with that of Ghana can be tricky, because along with a large difference in prices also exists great disparity in the quality and variety of goods and services available.  The comparison is interesting, nonetheless.  Allow me to explain.

Food and beverages likely constitute one of the largest areas of expenditure in our lives, so let me begin there.  If you are a bachelor in a large city in Ghana, like I am, you may not have family members who cook for you.  Because it is almost exclusively the females that prepare food in most African societies, your status as a single adult male means you are left with little choice than to buy your meals from women who sell food in small shacks along the streets and in back alleyways in the downtown area of the city.

These shacks are called Chop Bars and usually serve the following items: rice, fried or boiled plantains, fried chicken and fish, beans, spaghetti, boiled or fried yams, salad, and local dishes called banku, kenkey and fufuo, each of which is made from cooked corn, plantains, or cassava (or a combination of the three) that is pounded into a thick dough (imagine raw bread dough-- the appearance and consistency is the same) and eaten with either puréed red peppers, okra stew or soup made with peanut butter.  Other street vendors sell fried eggs and bread, porridge made from corn or millet, and coffee and tea in the mornings and late at night.  I eat breakfast, lunch and dinner from these chop bars every day.

Street food can also be purchased in a different way: it is common throughout the day to see women roaming the streets of the neighborhood in the scorching heat of the sun with a huge, heavy cauldron of cooked food balanced carefully on their heads and a bell to call out to customer ringing repeatedly in their left hand.

For breakfast, two fried eggs inside a large piece of bread costs around $0.55 and a large bowl of corn or millet porridge, or oatmeal, with milk and sugar is the same price.  A large mug of hot coffee or tea is $0.70.

For lunch and dinner, a large bowl of white rice with cabbage or tomato stew on top-- enough to constitute a meal-- costs about $0.50 at a chop bar or from a woman on the street.  A piece of fried chicken or fish is between $0.20 and $0.50 and a bowl of spaghetti noodles with tomato sauce and beans and salad on the side-- again, enough to call a meal-- costs about $0.60.

Awaakye is a dish that comes from the northern, predominantly Muslim region of Ghana and is made of brown beans and brown rice mixed together with your choice of spaghetti noodles, salad, fish, beef, or avocado on the side.  It is topped with a special kind of sauce and is usually eaten in the morning for breakfast (I eat it every morning-- it is delicious!).  A large, filling bowl will set you back around $0.60.

Various food items purchased on the street are also quite inexpensive.  A single large orange costs $0.07 and a banana is about $0.04.  A large pineapple or mango will cost around $0.50 and a large, juicy apple is $0.70.  A small bag of fried, sweet plantain chips is $0.14 and a small, homemade shortbread cookie is $0.07.  A glass bottle of Coca Cola, Sprite or Fanta is $0.40.

In total, my food and beverage expenses for one month are about $60.

Other than food, rent and transportation costs probably eat up a sizable portion of your income.  To rent a 15' x 15' single room in a house, with a shared bathroom, in Kumasi, a city of more than 2 million people, costs $7 per month, with an additional $4 for electricity and $3 for water per month.  A 15' x 15' bedroom with an additional 10' x 15' room attached, and a shared bathroom, is about $10 per month, with the added electricity and water costs just mentioned.  A private apartment with two large bedrooms, a full kitchen and bathroom, a large veranda and a small storage room costs around $100 per month-- expensive by local standards!

In regards to transportation, a majority of Ghanaians do not own a personal vehicle, so most people use public transportation, of which there are two main types: a taxi, either shared or private, and a 15-passenger mini-bus called a "tro-tro."  Tro-tros  A tro-tro from my house to the city center, which is probably only about 5 miles away, costs $0.14 and a taxi, shared with three other people, is $0.24 for the same trip.  A tro-tro trip about 16 across town costs $0.45.  The cost of a private, hired taxi varies because it is always subject to negotiation.  If you are a hard bargainer, you can drive the price down quite low.  The 5-mile trip from my house to the city center that costs $0.24 in a shared taxi is about $1.40 in a private, hired taxi.

In terms of long-distance travel, going from Kumasi to Accra, the capital, is a trip of 150 miles and about 5 hours, and costs $4 in a tro-tro.  The same trip in a large, air-conditioned coach bus is about $10.

Assuming I use a taxi or tro-tro every day, my monthly transportation costs are about $12.

When it comes to health care, costs clearly vary greatly depending on the seriousness of the illness and the extent of the services rendered.  In the United States, health care costs are generally extremely high-- far too much so, as most of those who do not have health insurance are prohibited from seeking basic health services because they cannot afford it.  My limited experience with health care in Ghana has given me an insight into the general cost of services.

In late 2009, I was admitted to the largest and best public hospital in Kumasi extremely dehydrated and with severe abdominal pain that had not ceased for the previous 16 hours.  It was later determined that I had kidney stones.  While at the hospital, I received a general physical examination from a doctor and underwent an ultra-sound scan of my abdomen.  I received an injection of pain medication and eight bags of saline solution administered intravenously throughout the one night that I spent in the hospital.  The following morning, I was given a 10-day supply of pain medication and was discharged.  The area of the hospital where I spent the night was newly-constructed and modern, with the look and feel of any reputable hospital in the United States.  The total cost of services, including medication and an overnight stay in the hospital, was $60.  Unbelievable.

Private hospitals are, of course, more expensive, but they still do not compare, in cost, to any hospital in the U.S.  A friend of mine underwent emergency surgery at a private hospital to remove one of her fallopian tubes.  The total cost of the surgery, 8 days in the hospital and medication was around $900.  Amazing, right?

I should note that public hospitals here are subsidized by the government so that average Ghanaians, whose incomes are very low, are able to access their services.

I must also say that although modern hospitals that use modern medical equipment do exist here, the quality of health care in Ghana, and throughout the developing world, is quite low and the range of service very limited in comparison to the United States or any other developed nation.  With this in mind, one would expect health care costs in Ghana to be lower than in the U.S.  But the extreme degree to which they are lower is a surprise to me.

Medicines purchased at a pharmacy are quite inexpensive, but the way in which they are bought and sold here deserves a bit of an explanation.

First, although doctors at hospitals do write prescriptions for the medications that their patients require, those same medicines can be purchased at any drug store in the country without a prescription.  So prescriptions are largely irrelevant, and are not needed in order to purchase any type of medication.  (Example: I have asthma.  To get an inhaler in the U.S., I must first visit a doctor and convince him that my need for an inhaler is genuine, at which point he will write a prescription.  The doctor's fee is probably at least $50 and the inhaler itself is another $20 to $30 at the pharmacy.  Expensive.  Here in Ghana, I walk into any pharmacy and purchase an inhaler of the same quality as the one in the U.S. for $7.  No questions asked; no prescription; no doctor's fees).

Second, medication here is sold in small quantities that are exactly what the customer needs at the time.  Complain of a headache and the pharmacy will give you a strip of 10 tablets of Paracetemol for $0.07 or a strip of 10 400mg Ibuprofen capsules for $0.21.  Want to buy a powerful prescription antibiotic but only need half of the dose/quantity contained in the package?  The pharmacy will open the box (breaking the safety seal) and use scissors to cut the strip of pills in half.  The remaining half will be sold to a different customer at another time--- without a prescription, of course.

A one-month supply of multi-vitamins is $0.42, Cod liver oil, a daily supplement, is $1.66 per month and garlic capsules, also a daily supplement, are $3.80 for one month.  Doxycycline, a common antibiotic that is taken daily as a malaria prophylaxis, is $2 for a one-month supply.  I once met an American man here who had paid more than $100 for a one-month supply of Doxycycline in the U.S.  Ridiculous.

Most of the medications sold here are generic brands that are manufactured at a very low cost in India.  Others are made right here in Ghana.  But the chemical composition, and thus the quality, of any generic medication, is identical to that of the popular brand name that you know well.  Am I wrong?  The problem, I believe, is that in the United States, many pharmacies do not stock these ultra-inexpensive medications coming out of India, probably because the profit margin on them is low and because the pharmaceutical companies know that Americans, in general, are able to purchase more expensive, name-brand drugs, so that is primarily what is offered on the market.  It could also be that the Indian large-scale producers of these inexpensive medications have it in their business plan to focus primarily on the developing world, perhaps as a kind of social responsibility to supply the world's poorest with medicine they desperately need and at a cost that they are able to bear.  I'm not exactly sure.

Clothes.  Most of us love to go shopping for new clothes, and we probably spend a lot of money in the process.  In Ghana, a lot of new clothes come from China and are of a very low quality.  The second-hand clothes market here is huge, however, and it is there that one finds quality, fashionable items for next-to-nothing.

There is a particular street in the downtown area where you will find huge piles of clothes on the ground lining the sidewalks for hundreds of feet-- all second-hand, imported from Europe and the United States, and all super cheap.  Long- and short-sleeved button-up shirts are separated into piles based on quality and price.  The lowest price is $0.70 per shirt-- all are free of stains and imperfections, but these tend to be older and less-fashionable than some of the more expensive shirts.  The next price is $1.40, and it is in these piles that one can find some killer shirts.  I once found two genuine Ralph Lauren long-sleeved polo shirts, each $1.40 and in perfect condition.  Most of the shirts come from Europe, and some are even custom-made from tailors in Italy, France and the United Kingdom.

Second-hand jeans, also from Europe and the U.S., are around $3 per pair.  A friend of mine once found a pair of Seven jeans for $5 (if you don't know, Seven jeans retail for something really ridiculous like $140 per pair).

Finally, let's talk about houses.  If you are ever interested in building your own home in Ghana and staying for awhile, you can be sure it won't break the bank.  A 3,500 to 4,000 square-foot (big!), two-story house with six or seven bedrooms and a few bathrooms, complete with a brick wall encircling the house and yard to provide privacy and security, can be constructed from scratch for around $60,000.  Seriously.