 Let me next turn to Dr. Juliette Tuakli who's the medical director and founder of Family Child and Associates in Ghana. A public health expert, a women and children health expert and practitioner and an academic. So a very nice overview, Nardo's of the issue. Juliette is from a practitioner's point of view. What are the challenges and opportunities and I think specifically you're going to talk a little bit about technology and the role of technology and in care going forward. Ghana's, most of you must know Ghana, I'm sure, but Ghana is in a rather unique position in so far as it is one of the countries that is hailed as doing very well with its national health service, with its capacity to try to raise the level, the standard of care for most of its citizens, which is all true. I think Ghana didn't fall into the trap of providing free care at the national health service level because I think, and I was certainly in agreement, getting anything for free in any population probably is not a good idea and health is no exception. Even if what you pay is minuscule and so the government in its wisdom has charged a very, very, very modest amount to those citizens who are eligible for national health service and have rolled out a pretty impressive program. The problem with Ghana is that it is in the middle of the West African hub and some of our larger neighbors, such as Nigeria, where I'm from, I'm not saying this to be negative, do use services as do many of the other countries, Liberia is another case in point. Certainly in my practice we see people from all of the West African countries, especially Nigeria and Liberia, where the services really are much poorer than they are in Ghana and certainly they do have a deficit at the public health level. But even within Ghana, even within the national health service, which has been designed to provide to the best of its ability a broad coverage to a relatively large population, there are gaps which I consider to be quite important and yesterday listening to Paul Kagame, I was reminded of this, because within the national health service there's no special area for women to seek care and traditionally women will not seek care until their children, their family have been taken care of and it does show up when we look at the statistics of the services that are provided number one and if you look specifically at the health status of women who are enrolled and registered with the national health service so I think there needs to be a little bit of tweaking so we can empower and advocate access, more access if you will, for women specifically. We have done a good job with lowering child mortality and morbidity actually, but we have beautiful shiny new roads, courtesy of China and other large countries and the rate of road traffic accidents is beginning to negate some of the gains that we have made regarding some of our mortality and morbidity. It's an ironic situation. Many of us in the public health sector had been monitoring the rise of non-communicable diseases. Obesity is particularly important, diabetes is another, hypertension is almost epidemic, but certainly when one looks at the specific numbers one will see that road traffic accidents trump all and it's definitely been increasing with the number of roads, that number of highways. Public health issues were not taken into account by and large when some of these roads were implemented, i.e. crossovers for pedestrians to use, side roads for school children to use, even roads for bicyclists to use, we have large number of people who do cycle when they can't afford motor vehicles, and so they are fair game, unfortunately along with the goats and the cows and other things that sort of find their way onto the highways and I really think we need to, within the National Health Service, also look at road safety education for the children at the school level, primary school level perhaps even further up because it's becoming a major problem, absolutely major and a lot of the accidents certainly could be avoided and it's got nothing to do with drunk driving, this is just a child who tries to cross the road, doesn't regulate the speed of the oncoming vehicle and gets knocked over and it's happening far too frequently, particularly amongst the younger population. So that is a bit worrying I have to say and then the other reason Ghana has a little bit of a strain on its system is because we're the hub for the counterfeit drug system and as Brian had mentioned it is a huge business, 1.7 trillion US dollar business per annum, it is not small. There are several major countries involved both in Africa and outside of the continent who are pushing these medicines. There is some pushback coming on board where we have some technological firms developing scratch cards, the system of the scratch card method that a purchaser can scratch the silver foil on the medication and use their app on their phone to see whether it is a legitimate drug or not and a company called Sproxel is now working in Nigeria, in Ghana, in Tanzania and I think even in Senegal and certainly I think it's a fabulous program because it involves the government at a very high level as well as the drug manufacturers but most importantly one doesn't have to be literate to use it. I think that many of the programs that we do have often presume a level of literacy that is not always present. What I like about this particular program and why I pray that it will be successful is that everybody, I mean 80% of our population have mobile phones and 80% of them are used to refilling their services using the scratch card method so I think it's a very, very, very important intervention that needs also to be promoted and supported. Nardo spoke about leadership. Leadership really is essential. At the current time we have a president's wife who is very supportive of many of the health interventions that are coming on board. The president himself eloquently discusses them but it's actually been his wife I've noticed who has been much more involved in trying to make sure these advances are sustained and implemented. I think also the last but not least point is the issue of geographic access which is why I think technology is so important. We have some very remote areas in Ghana where you don't have as much telephony as you have elsewhere and so you'll find that access is limited and of course this is often where outbreaks occur. People aren't aware of it until it becomes a community epidemic and one is then scrambling to try to contain preventable outbreaks. But I do think as I discussed earlier that technology might provide us with a bridge to leapfrog over some of our infrastructural deficits and certainly with the sproxel example I gave you regarding the counterfeit drugs I think that's an excellent application of technology. I can speak more to this a bit later but I'll stop there. The roads and the accidents on roads just remind me that the two common threads are this transition that countries in Africa are between emerging economies and developed and that they're not always planned for the Passover. The roads issue is the perfect one.