Betty Krampa is a prisoner, thanks to the World Bank and the IMF. She has just given birth. She is sitting on her rickety metal bed in the corridor of Tarkwa general hospital. She's not being allowed to leave until she comes up with the money.

The policy is called cash and carry. Patients pay for everything - for surgery, drugs, blood, scalpel, even the cotton wool. Betty's parents are dead. Her husband is out of work. Her jailers are as ashamed as she is. But user fees have to be collected to keep the hospital going.

Ghana is now deeply in debt

Ghana used to be called the model pupil. Now after 20 years of economic fundamentalism, what does it have to show for it? It's now about to join the ignominious club of highly indebted poor countries.

So, if the economic experiment has failed in a place like Ghana, what chances for anywhere else?

The poor have to pay for all the essentials of life, for education; for clean drinking water - even to go to the toilet.

A mile or so down the road from the hospital, I come across Mary Agyekum. She breaks stones for a living. Small flint hammer in hand, she sits on the parched ground under the sun, 12 hours a day, chipping away at boulders.

Her children help her out. If she's lucky, she receives 2 a week.

Paying school fees is a struggle

She tells me of her shame, of the pains she feels carrying her heavy loads of stones. She can only send two of her children to school now, but they are chased home by the teachers if she hasn't paid the fees on time.

Mary begins each day with a trip to the public toilet. If she's run out of money, she begs the woman at the booth to let her children in for free. Then she walks to the nearest borehole where she pays for a bucket of water.

This is what the World Bank calls 'full cost recovery'.

The Agyekum family used to live well. They owned a farm. Then one day a mining company forced them off their farming land and took away their livelihood.

It's a familiar story here. Two thirds of the land in this region has been sold off to multinationals. Compensation is minimal.

Little of the wealth from gold goes to the people

Tarkwa is at heart of Ghana's gold mining industry. Gold may be the country's biggest export earner, but the people get nothing out of it. Urged on by the international institutions, the government allows mining firms to operate virtually tax-free for up to 10 years. Environmental and other regulations are kept to a minimum.

My journey across Ghana took me from the capital, to the mining region of the west to the rice growing area of the north. I was joined by Yao Graham, a Ghanaian activist who travels across the developing world, listening to communities' specific grievances and taking them onto the global stage - to institutions like the IMF and World Bank.

Poverty and terrorism

Yao's reaction to the events of 11 September was typical of many here. He was shocked and horrified. And yet, what struck me was the speed with which so many Ghanaians - as pro-British and pro-American as they are - made a link between terrorism and poverty.

"We're living in a world where so many people are feeling taken for granted," he tells me, "that unless the big powers become more sensitive to the demands of weaker countries, all of us are endangered."

Salutary lessons learned

The international institutions don't try too hard any more to defend their record. Peter Harrold, the World Bank's man in Ghana, admitted that global inequality was posing a much more immediate danger now.

And what about the IMF? "You learn that economic growth doesn't necessarily mean you're tackling social problems", its representative, Girma Begashaw, told me. Why, I asked, had it taken so long for this to dawn on him? All of us, he said, have to learn from experience.

And yet, in spite of the rhetoric, the attempts at contrition, in the villages the same economic fundamentalism is still being applied with the same vigour.

Why American rice?

In the village of Kpembe, I came across Azara Issah. She was filling her bucket with water from a dam she knew was infested with guinea worm. She didn't have the money to pay for clean water at the local pump.

The village chief invited us for lunch. We ate chicken feet, soup and rice - American rice. A mile away is the Katanga valley, once Ghana's rice bowl. It now lies fallow.

Ghana now imports rice

Ghana used to be self sufficient in rice. But then the World Bank and IMF decreed that markets had to open and subsidies had to stop.

Wherever I looked, I saw double standards. People here have to pay for the essentials of life, like water. In America, the government pours millions of dollars each year into propping up its water system.

And why is American rice the staple now for Ghanaians? Yes, you've guessed it. American rice is subsidised.