Aaron M. Secrest,
MD, PhD, MBA
Languages Spoken: English
Aaron Secrest, MD, PhD, MBA, brings clinical expertise in general adult and pediatric dermatology to Davis and Weber Counties with his main office at Farmington Health Center. He also has a half-day clinic at the University Hospital outpatient clinic each week. He treats a broad range of common skin disorders, such as acne (teenage and adult female acne), eczema, warts, and skin cancer. His particular focus is understanding what matters most to his patients and how his patients' skin issues affect their quality of life. To help him, Dr. Secrest encourages his patients to complete a quality of life assessment called Skindex-16 at every visit. Skindex-16 asks questions to help Dr. Secrest and his patients understand how their skin issues are affecting their symptoms, their emotions, and their ability to function. Skindex-16 is particularly useful because it helps Dr. Secrest track how his patients feel their skin issues doing - are they getting better or worse over time? His patients can request copies of their Skindex-16 scores at any time to see how they are doing.
Recently, Dr. Secrest completed an MBA at the University of Utah to help him understand the business side of medicine to try to find ways to help improve how healthcare works in the U.S. Dr. Secrest is keenly aware of how insurances are changing over the years, and often, patients are required to pay for more of their care and their treatments out-of-pocket. Dr. Secrest spends time trying to identify the most cost-effective care for his patients, even if that means the best treatment is over-the-counter. Please let Dr. Secrest know if you have a high-deductible plan, so he can ensure you get the best value out of your care.
Dr. Secrest is Vice Chair of Business Strategy for Dermatology and an Assistant Professor in the Departments of Dermatology and Population Health Sciences at the University of Utah, where, in addition to seeing patients, he does research on quality of life, access to care, and costs of care in dermatology. He is board-certified in dermatology and a member of both the American Academy of Dermatology and the Society for Pediatric Dermatology. He completed an intern year at Cincinnati Children's Hospital prior to his dermatology training at the University of Utah, where he served as a chief resident.
Clinical Locations
801-581-2955
Specialties
Board Certification and Academic Information
| Academic Departments | Dermatology
-
Assistant Professor Population Health Sciences - Adjunct Assistant Professor |
| Board Certification | American Board of Dermatology |
Patient Rating
The Patient Rating score is an average of all responses to care provider related questions on our nationally-recognized Press Ganey Patient Satisfaction Survey.
Responses are measured on a scale of 1 to 5 with 5 being the best score.
Likelihood of recommending care provider
4.8/ 5
Care provider's explanation of condition/problem
4.8/ 5
Care provider's effort to include me in decisions
4.8/ 5
Wait time at clinic
4.5/ 5
Care provider's concern for questions & worries
4.9/ 5
Patient Comments
Patient comments are gathered from our Press Ganey Patient Satisfaction Survery and displayed in their entirety. Patients are de-identified for confidentiality and patient privacy.
UofU Patient
July 31, 2021
UH HOSPITALS AND CLINICS
Dr. Secrest gave me a few options to choose from. Talked about the pros and cons of each, and even talked about the cost of various treatments to help make a decision.
UofU Patient
July 18, 2021
FARMINGTON HEALTH CENTER
Thank You
UofU Patient
July 18, 2021
FARMINGTON HEALTH CENTER
Dr. Secrest was excellent, knowledgeable, and friendly. His personality was wonderful. He made the visit great and communicated like a friend.
UofU Patient
July 16, 2021
FARMINGTON HEALTH CENTER
He gave options
UofU Patient
June 29, 2021
FARMINGTON HEALTH CENTER
Dr. Secrest was great! Would definitely recommend.
UofU Patient
June 27, 2021
FARMINGTON HEALTH CENTER
Nothing but excellent He really is so caring soft spoken and showed such interest in my concerns
UofU Patient
June 26, 2021
UH HOSPITALS AND CLINICS
I would rate higher if possible. High quality care. I was very happy with the treatment I was given.
UofU Patient
June 19, 2021
UH HOSPITALS AND CLINICS
Dr Secrest was fantastic. While being highly professional, he was also very personable, informative, and caring - in addition to being both humorous and interesting. If only all my interactions with medical professionals could be like this one!! Well done, Dr Secrest!
UofU Patient
June 08, 2021
FARMINGTON HEALTH CENTER
Dr. Secrest is the best!
UofU Patient
May 15, 2021
UH HOSPITALS AND CLINICS
Dr. Secrets was very courteous and friendly. I couldn't have asked for a better treatment!
UofU Patient
May 12, 2021
FARMINGTON HEALTH CENTER
dr.Secrest is pleasant,friendly and thoughtful as well as thorough.
UofU Patient
May 10, 2021
FARMINGTON HEALTH CENTER
Always appreciate seeing Dr. Secrest and receiving his help.
UofU Patient
May 07, 2021
FARMINGTON HEALTH CENTER
Patients care about 1) if they doctor truly listened 2) received a quality outcome from the visit. Dr. Secrest's excels at both of these points.
UofU Patient
April 30, 2021
FARMINGTON HEALTH CENTER
cannnot say enough good things about dr seacrest and his staff
UofU Patient
April 25, 2021
FARMINGTON HEALTH CENTER
Dr Seachrist is so nice. he makes everything easy to understand.
UofU Patient
April 25, 2021
UH HOSPITALS AND CLINICS
Dr. Secrest quickly addressed my concerns and kept the visit efficient and focused.
UofU Patient
April 23, 2021
FARMINGTON HEALTH CENTER
Dr. Secrest was friendly, personable and happy to answer my questions.
UofU Patient
April 19, 2021
FARMINGTON HEALTH CENTER
Dr Secrist was awesome! I felt very at ease with him. He made me feel that I was talking to a friend.
UofU Patient
April 18, 2021
FARMINGTON HEALTH CENTER
good
UofU Patient
April 09, 2021
FARMINGTON HEALTH CENTER
good
UofU Patient
April 05, 2021
FARMINGTON HEALTH CENTER
excellent dr and staff! above and beyond!! helpful, knowledgeable, and kind. love them
UofU Patient
April 04, 2021
FARMINGTON HEALTH CENTER
we love Dr Secrest
UofU Patient
April 02, 2021
FARMINGTON HEALTH CENTER
listened well and explained clearly
UofU Patient
March 28, 2021
FARMINGTON HEALTH CENTER
Dr. Secrest was a pleasure, after a bad experience with my former dermatologist I was nervous about coming in. Dr. Secrest made me feel at ease from the get go, listened to and address my concerns.
UofU Patient
March 27, 2021
UH HOSPITALS AND CLINICS
I appreciated his concern for my financial challenges as well as my health!
UofU Patient
March 22, 2021
FARMINGTON HEALTH CENTER
excellent experience!
UofU Patient
March 19, 2021
FARMINGTON HEALTH CENTER
good
UofU Patient
March 12, 2021
FARMINGTON HEALTH CENTER
I'm very confident in Dr Seacrest's care and concern for me.
UofU Patient
March 06, 2021
UH HOSPITALS AND CLINICS
Dr. Seacrest was VERY attentive and relieved a lot of anxiety I had about my issue! Eased my nervousness and reassured me "i would get better"! I felt very relieved after my visit, that's for sure!
UofU Patient
March 03, 2021
FARMINGTON HEALTH CENTER
Dr. Secrest is the best. He is fun to talk to and very informative. I was asking about some cosmetic issues with my skin and he was so knowledgeable and new exactly what would help. Him and his MA Jessica made me feel so welcome, listened to what my concerns were and gave great suggestions. I would recommend him to anyone who was looking for a dermatologist.
UofU Patient
March 01, 2021
FARMINGTON HEALTH CENTER
Phenomenal Care!
UofU Patient
February 26, 2021
FARMINGTON HEALTH CENTER
I liked that she was honest and up front with me!
UofU Patient
February 26, 2021
FARMINGTON HEALTH CENTER
very personable very kind very informed
UofU Patient
February 05, 2021
FARMINGTON HEALTH CENTER
he is one of the best doctors I have ever seen.
UofU Patient
February 01, 2021
UH HOSPITALS AND CLINICS
Dr. Secrest made me feel reassured and showed concern. He also complemented me on the progress that I had made.
UofU Patient
January 31, 2021
FARMINGTON HEALTH CENTER
I've recommended Dr. Secrest to several friends. He's got a great sense of humor but keeps it professional. love his staff.
UofU Patient
January 10, 2021
FARMINGTON HEALTH CENTER
loved Dr. Secrest. he was amazing with my 5 year old who was already a nervous wreck.
UofU Patient
December 27, 2020
FARMINGTON HEALTH CENTER
Dr. Secrest was completely focused on my Healthcare during the entire visit, I couldn't be more pleased.
UofU Patient
December 20, 2020
FARMINGTON HEALTH CENTER
Dr Secrest is absolutely the best dermatologist I've ever been to. He's personable, kind, relatable and doesn't make you uncomfortable in any way when discussing issues.
UofU Patient
November 28, 2020
UH HOSPITALS AND CLINICS
Excellent care for my daughter.
UofU Patient
November 13, 2020
FARMINGTON HEALTH CENTER
Great Job
UofU Patient
November 10, 2020
FARMINGTON HEALTH CENTER
Very impressed
UofU Patient
November 06, 2020
FARMINGTON HEALTH CENTER
good experience. both dr secrest and staff are great to work with.
UofU Patient
November 03, 2020
FARMINGTON HEALTH CENTER
Dr. Secrest was very efficient, answered all my questions, and more, and I will definitely be back to see him in the future. I am also scheduling my husband to see him soon, and anyone else who asks for a referral.
UofU Patient
October 28, 2020
FARMINGTON HEALTH CENTER
He is amazing. He took care of the problems I was having with my skin, but he actually helped me with some things I was depressed about too. He made me feel positive and happy. He has a great caring personality. I still think of some of the advise or ideas daily. I am happier and friendlier to people. He didnt make me feel that I was an old lady that didnt matter
UofU Patient
October 20, 2020
UH HOSPITALS AND CLINICS
Dr. Secrest was wonderful. He explained the medication to me thoroughly and he said that I could contact him in lieu of an appointment.
UofU Patient
October 10, 2020
FARMINGTON HEALTH CENTER
This provider was recommended to me by some of my coworkers. He is great!
UofU Patient
September 26, 2020
FARMINGTON HEALTH CENTER
overall explanation of my condition and results of procedure was very good
UofU Patient
September 20, 2020
UH HOSPITALS AND CLINICS
I had a really good experience with Dr. Secreast. I debated on making this appointment because I felt like it was such a small issue but he was really nice in explaining that I shouldn't feel bad and if it is a problem for me then it needs to be taken care of. He also did the procedure that same appointment I which I appreciated because my schedule is a little rough to work with. He was also really good at explaining the procedure and what to expect afterwards when the wound heals.
UofU Patient
September 15, 2020
FARMINGTON HEALTH CENTER
Dr. Seacrest was beyond amazing and professional. I felt safe and fully trusted him, my anxiety level was low. I felt very positive when I left. this hasn't always been the case after negligence at ihc. it's very difficult now to go to the doctors, especially a new one. I was very impressed with Dr Seacrest, his entire staff. you could tell it was a great place to not only be a patient, but also work. standard it seems fir all my appointments and providers at University of Utah facilities. thank you.
Aaron Secrest, MD, PhD, MBA, brings clinical expertise in general adult and pediatric dermatology to Davis and Weber Counties with his main office at Farmington Health Center. He also has a half-day clinic at the University Hospital outpatient clinic each week. He treats a broad range of common skin disorders, such as acne (teenage and adult female acne), eczema, warts, and skin cancer. His particular focus is understanding what matters most to his patients and how his patients' skin issues affect their quality of life. To help him, Dr. Secrest encourages his patients to complete a quality of life assessment called Skindex-16 at every visit. Skindex-16 asks questions to help Dr. Secrest and his patients understand how their skin issues are affecting their symptoms, their emotions, and their ability to function. Skindex-16 is particularly useful because it helps Dr. Secrest track how his patients feel their skin issues doing - are they getting better or worse over time? His patients can request copies of their Skindex-16 scores at any time to see how they are doing.
Recently, Dr. Secrest completed an MBA at the University of Utah to help him understand the business side of medicine to try to find ways to help improve how healthcare works in the U.S. Dr. Secrest is keenly aware of how insurances are changing over the years, and often, patients are required to pay for more of their care and their treatments out-of-pocket. Dr. Secrest spends time trying to identify the most cost-effective care for his patients, even if that means the best treatment is over-the-counter. Please let Dr. Secrest know if you have a high-deductible plan, so he can ensure you get the best value out of your care.
Dr. Secrest is Vice Chair of Business Strategy for Dermatology and an Assistant Professor in the Departments of Dermatology and Population Health Sciences at the University of Utah, where, in addition to seeing patients, he does research on quality of life, access to care, and costs of care in dermatology. He is board-certified in dermatology and a member of both the American Academy of Dermatology and the Society for Pediatric Dermatology. He completed an intern year at Cincinnati Children's Hospital prior to his dermatology training at the University of Utah, where he served as a chief resident.
Academic Locations
School of Medicine
801-581-6465
Board Certification and Academic Information
| Academic Departments | Dermatology
-
Assistant Professor Population Health Sciences - Adjunct Assistant Professor |
| Board Certification | American Board of Dermatology |
Research Interests
- Patient Reported Outcomes
- Epidemiology
- Population Health Management and Quality Improvement
- Melanoma
- Nonmelanoma Skin Cancers
- Drug Costs
- Health Care Costs
- Dermatitis
Education History
| Graduate Training | University of Utah Eccles School of Business M.B.A. |
| Chief Resident | University of Utah School of Medicine Dermatology Chief Resident |
| Residency | University of Utah School of Medicine Dermatology Resident |
| Internship/Residency | Cincinnati Children’s Hospital Medical Center Pediatrics Intern/Resident |
| Professional Medical | University of Pittsburgh Medicine M.D. |
| Doctoral Training | University of Pittsburgh Epidemiology Ph.D. |
| Graduate Training | University of Pittsburgh Epidemiology M.P.H. |
| Undergraduate | Brigham Young University Major: Microbiology: Minors: Asian Studies, Business Management B.S. |
Selected Publications - Journal Articles
Journal Article
- Anderson A, Matsumoto M, Secrest A, Saul MI, Ho J, Ferris LK (2022). Cost of Treatment of Benign and Premalignant Lesions During Skin Cancer Screening. JAMA Dermatol, 157(7), 876-879.
- Kennedy J, Arey S, Hopkins Z, Tejasvi T, Farah R, Secrest AM, Lipoff JB (2022). Dermatologist Perceptions of Teledermatology Implementation and Future Use After COVID-19: Demographics, Barriers, and Insights. JAMA Dermatol, 157(5), 595-597.
- Taliercio V, Langner AU, Secrest AM, Duffin KC (2021). Assessing psoriasis severity: psychometric validation of overall physician global assessment (OPGA). (Epub ahead of print) J Am Acad Dermatol.
- Clark JJ, Snyder AM, Sreekantaswamy SA, Petersen MJ, Lewis BKH, Secrest AM, Florell SR (2021). Dermatologic care of incarcerated patients: A single-center descriptive study of teledermatology and face-to-face encounters. (Epub ahead of print) J Am Acad Dermatol.
- Flint ND, Bishop MD, Smart TC, Strunck JL, Boucher KM, Grossman D, Secrest AM (2020). Low accuracy of self-reported family history of melanoma in high-risk patients. Fam Cancer, 20(1), 41-48.
- Secrest AM, Hopkins ZH, Frost ZE, Taliercio VL, Edwards LD, Biber JE, Chen SC, Chren MM, Ferris LK, Kean J, Hess R, Dermatology PRO Consortium (2020). Quality of Life Assessed Using Skindex-16 Scores Among Patients With Acne Receiving Isotretinoin Treatment. JAMA Dermatol, 156(10), 1098-1106.
- Carlisle RP, Flint ND, Hopkins ZH, Eliason MJ, Duffin KC, Secrest AM (2021). Administrative Burden and Costs of Prior Authorizations in a Dermatology Department. JAMA Dermatol, 156(10), 1074-1078.
- Laggis CW, Secrest AM, Agyei M, Simister S, Davis AN, Dickerson T, Rhoads JL (2020). The Impact of Skin Disease on Quality of Life in Rural Communities of Ghana. SKIN The Journal of Cutaneous Medicine, 4(5), 417-423.
- Truong A, Secrest AM, Zhang M, Forbes BR, Laggis CW, McFadden M, Gardner LJ, Powell DL, Lewis BKH (2020). A survey of dermatologic health-related quality of life and resource access in patients experiencing homelessness. (Epub ahead of print) J Am Acad Dermatol.
- Strunck JL, Smart TC, Boucher KM, Secrest AM, Grossman D (2020). Improved melanoma outcomes and survival in patients monitored by total body photography: A natural experiment. J Dermatol, 47(4), 342-347.
- Gaufin M, Hess R, Hopkins ZH, Biber JE, Secrest AM (2019). Practical screening for depression in dermatology: using technology to improve care. Br J Dermatol, 182(3), 786-787.
- Hopkins ZH, Moreno C, Secrest AM (2020). Influence of Social Media on Cosmetic Procedure Interest. J Clin Aesthet Dermatol, 13(1), 28-31.
- Hopkins ZH, Secrest AM (2019). Public Health Implications of Google Searches for Sunscreen, Sunburn, Skin Cancer, and Melanoma in the United States. Am J Health Promot, 33(4), 611-615.
- Hopkins ZH, Moreno C, Secrest AM (2019). Lack of confidence interval reporting in dermatology: a call to action. Br J Dermatol, 180(4), 910-915.
- Hopkins ZH, Secrest AM (2019). An international comparison of Google searches for sunscreen, sunburn, skin cancer, and melanoma: Current trends and public health implications. Photodermatology, Photoimmunology & Photomedicine Online, 35(2), 87-92.
- Grossman D, Farnham JM, Hyngstrom J, Klapperich ME, Secrest AM, Empey S, Bowen GM, Wada D, Andtbacka RHI, Grossmann K, Bowles TL, Cannon-Albright LA (2018). Similar survival of patients with multiple versus single primary melanomas based on Utah Surveillance, Epidemiology, and End Results data (1973-2011). J Am Acad Dermatol, 79(2), 238-244.
- Anderson AM, Matsumoto M, Saul MI, Secrest AM, Ferris LK (2018). Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists in a Large Health Care System. JAMA Dermatol, 154(5), 569-573.
- Matsumoto M, Secrest A, Anderson A, Saul MI, Ho J, Kirkwood JM, Ferris LK (2018). Estimating the cost of skin cancer detection by dermatology providers in a large health care system. J Am Acad Dermatol, 78(4), 701-709.e1.
- Secrest AM, Asgari MM, Kourosh AS, Barbieri JS, Albrecht J (2017). Prior authorizations for dermatologic medications: An American Academy of Dermatology survey of US dermatology providers and staff. J Am Acad Dermatol, 77(4), 784-786.
- Andrulonis R, Secrest AM, Patton TJ, Grandinetti LM, Ferris LK (2017). A cross-sectional study of indoor tanning use among patients seeking skin cancer screening. J Am Acad Dermatol, 76(1), 164-165.
- Houston NA, Secrest AM, Harris RJ, Mori WS, Eliason MJ, Phillips CM, Ferris LK (2016). Patient Preferences During Skin Cancer Screening Examination. JAMA Dermatol, 152(9), 1052-4.
- Clark JJ, Secrest AM, Hull CM, Eliason MJ, Leiferman KM, Gleich GJ, Powell DL (2016). The effect of omalizumab dosing and frequency in chronic idiopathic urticaria: Retrospective chart review. J Am Acad Dermatol, 74(6), 1274-6.
- Saluja SS, Secrest AM, Florell SR (2016). Acute Presentation of Tender Papules and Plaques in a Patient With Leukemia. JAMA Dermatol, 152(5), 571-2.
- Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ (2012). Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort. Diabetes, 61(11), 2987-92.
- McGuire ST, Secrest AM, Andrulonis R, Ferris LK (2011). Surveillance of patients for early detection of melanoma: patterns in dermatologist vs patient discovery. Arch Dermatol, 147(6), 673-8.
- Secrest AM, Costacou T, Gutelius B, Miller RG, Songer TJ, Orchard TJ (2011). Association of socioeconomic status with mortality in type 1 diabetes: the Pittsburgh epidemiology of diabetes complications study. Ann Epidemiol, 21(5), 367-73.
- Secrest AM, Becker DJ, Kelsey SF, Laporte RE, Orchard TJ (2011). Characterizing sudden death and dead-in-bed syndrome in Type 1 diabetes: analysis from two childhood-onset Type 1 diabetes registries. Diabetic Medicine Online, 28(3), 293-300.
- Secrest AM, Becker DJ, Kelsey SF, LaPorte RE, Orchard TJ (2010). All-cause mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes: the Allegheny County type 1 diabetes registry. Diabetes Care, 33(12), 2573-9.
- Secrest AM, Becker DJ, Kelsey SF, Laporte RE, Orchard TJ (2010). Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes, 59(12), 3216-22.
- Orchard TJ, Secrest AM, Miller RG, Costacou T (2010). In the absence of renal disease, 20 year mortality risk in type 1 diabetes is comparable to that of the general population: a report from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetologia, 53(11), 2312-9.
- Andrulonis R, Secrest AM, McGuire ST, Geskin LJ, Ferris LK (2010). The influence of age and sex on reasons for seeking and expected benefits of skin cancer screening. Arch Dermatol, 146(10), 1097-102.
Review
- Thomas LW, Elsensohn A, Bergheim T, Shiu J, Ganesan A, Secrest A (2018). Intramuscular Steroids in the Treatment of Dermatologic Disease: A Systematic Review. [Review]. J Drugs Dermatol, 17(3), 323-329.
- Collins MK, Secrest AM, Ferris LK (2014). Screening for melanoma. [Review]. Melanoma Res, 24(5), 428-36.
Book Chapter
- Secrest AM, Washington RE, Orchard TJ (2017). Chapter 35. Mortality in type 1 diabetes. In Cowie CC, Casagrande SS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, Gregg EW, Knowler WC, Barrett-Connor E, Becker DJ, Brancati FL, Boyko EJ, Herman WH, Howard BV, Narayan KMV, Rewers M, Fradkin JE (Eds.), Diabetes in America (3rd, pp. 35.1-35.16). Bethesda, MD: National Institutes of Health, NIH Pub No. 17-1468.
Editorial
- Abuabara K, Asgari MM, Chen SC, Dellavalle RP, Kalia S, Secrest AM, Silverberg JI, Solomon JA, Weinstock MA, Wu JJ, Chren MM (2018 Aug). How data can deliver for dermatology. 79(2), 400-402.
Letter
- Ma BC, Sahni VN, Edwards LD, Sahni DR, Secrest AM (2021). Response to 'A call to standardize the BCC:SCC ratio'. [Letter to the editor]. Br J Dermatol.
- Laggis CW, Lamb A, Secrest AM, Ufkes N, Halwani AS, Tao R, Gaffney D, Miles RR, Florell SR, Wada D (2020). Favourable outcomes in folliculotropic mycosis fungoides after multimodality treatment in a single institution. [Letter to the editor]. J Eur Acad Dermatol Venereol, 35(1), e42-e45.
- Truong A, Secrest AM, Fino NF, Laggis CW, Lewis BKH (2020). Homeless status and associations with treatment disparities for common skin conditions. [Letter to the editor]. Br J Dermatol, 183(3), 582-584.
- Truong A, Laggis CW, Annis TD, Secrest AM, Fino NF, Powell DL, Gardner LJ, Gregory T, Hull CM, Lewis BKH (2019). Factors associated with follow-up adherence in patients seen at a referral-based dermatology clinic for the homeless. [Letter to the editor]. J Am Acad Dermatol, 83(2), 629-631.
- Secrest AM, Chren MM, Hopkins ZH, Chen SC, Ferris LK, Hess R (2019). Benefits to patient care of electronically capturing patient-reported outcomes in dermatology. [Letter to the editor]. Br J Dermatol, 181(4), 826-827.
Global Impact
Selected Provider Publications
Journal Article
Laggis CW, Secrest AM, Agyei M, Simister S, Davis AN, Dickerson T, Rhoads JL (2020). The Impact of Skin Disease on Quality of Life in Rural Communities of Ghana. SKIN The Journal of Cutaneous Medicine, 4(5), 417-423.
Global Impact: Ghana.