On our way to the village of Danfa, where we were to conduct our community health diagnosis, it all became clear to me why the roads that we had driven on were being so developed. I learned from one of our interpreters that there was a new presidential palace being constructed on the top of the mountain past Mampong Regional Hospital. I learned that the roads before had been very precarious and dangerous, but nevertheless the entire route from the main road near our hostel in Accra-Shiashie all the way up to the mountain communities near the palace saw road development to the extreme. It was to be the president’s new driveway. The longest driveway that I know of, but when you get a police motorcade that clears the roads to take you home, why not have a smooth path in the name of development? This makes me wonder. . . will the surrounding communities benefit? Will they get development help and road improvements? I think not as evidenced by the poor side roads and lack of interest in rural communities (or so it seems). Is a long driveway really necessary (too much snow in Michigan)?
17 June 2007
We arrived back in Danfa, as we had previously visited, and moved into our guest house near the community health clinic. The clinic was constructed back in 1969 with the help of the University of California (no one knows which one) and serves six local communities of over 60,000 people. Many medical students stay in the guest housing to conduct community health diagnoses. This is why ours was to be in the village of Otinibi, just down the road about two kilometers. We were to interview four individuals with pre-determined backgrounds to see how well the community was doing in regards to health. Here is where many students first saw a very rural village with not much development. However, here there was a fair degree of development due to the involvement of the University of California and other NGOs from the UK and Norway. This is where I felt most welcome and at ease. There is no rushing in the village, there are no hawkers, no one will lie to you for help, the scenery is beautiful – mountains in the background, heart wrenching picture opportunities of children, the freedom of the wilderness, there is just such a better atmosphere and disposition that it is very difficult to explain. It is because of villages like these that I fell in love with Africa. The guest house was a very nice place where we could all live, cook, clean, and work together. Everyone took turns cooking a meal and cleaning up, playing cards, singing songs, kicking a soccer ball around, and just having a good time. Hurrah for group bonding!
18 June 2007
The very next day we awoke early to cook (Team 3) oats, eggs, and cinnamon toast – believe me this is an amazing breakfast. After eating we met our interpreters for the day. They would assist us in interviewing community members about health practices. We split into groups and were assigned an interpreter. Elkanne, 18 years old and son of our coordinator, was our interpreter.
He was a very nice kid and was very good at helping us understand the health of the community. We walked the two kilometers to Otinibi and began interviewing. The village is like many that we have seen here. In the early stages of ‘development,’ a hardworking chief, mud buildings, sheet metal roofs, no defined pathways, a borehole for water, coconut trees, and lots of ‘bush.’ The village is beautiful and I can’t get enough of it. We conducted our interviews, meeting a great array of people from a man who spoke for his wife, a not so enthusiastic bachelor, and an awesome grandmother who supposedly grows the best of the best peppers. 
We learned of many different aspects of community health and saw a great deal of the community to assess its health. We chatted with the chief as he passed by and attempted to climb coconut trees. Elkanne was much better than I was.
While we were heading back to our guest house in Danfa, after completing interviews, we passed by a kente cloth weaving ‘factory’ of sorts. We came across a young boy weaving so fast and with such skill, it was amazing. Later we found out that this was a place of child labour and that these children did not attend school, which is against the law. On leaving we informed the chief and he said that he was going to register all the children in the area who were supposed to be in school. He would then confront the man running the operation and extend some help for the children.
The Interpreters:
Our Findings
We identified four key areas that contributed to the community health of Otinibi: Nutrition, Sanitation, Water Source, and Health Service Use. Each of the four people we interviewed told us that they ate only kenkey (pounded maize) and fufu (pounded cassava), none of then had anything else to supplement their diets. No fruits, no proteins, no vegetables. We wondered what effect this had on the community health as much of the diet was composed of starch. We then asked about waste removal and everyone told us that they used the dump by the bush, only the grandmother told us that sometimes they burned it. For human waste they all went to the bush, which as you may guess is very unhygenic. The public toilets have been broken for some years (collapsed). This moved us into asking where the families got their water. There is a newly installed pipe tap which everyone said they used, but we were told that it cost 200 cedis per bucket. Is this really the primary source of water? I can’t imagine everyone paying for a bucket of water every time they need it. Before the tap, the community used the borehole (pump well) to get water. Everyone told us that they knew the water was safe to drink because they drank it and didn’t get sick. Or did they? This is where we wondered if the common ailments of headache and fever, which were diagnosed as malaria, were really due to the water. There was also a stagnant pond that some people used to get water for bathing.
As far as the decision of what medicine to use, we observed self-medication, use of orthodox and traditional medicines. In the community everyone told us that the Danfa Clinic was their number one choice of medical care. I contributed this to the construction of the Danfa Clinic and the subsequent outreach programs conducted in the surrounding communities. No one, except the grandmother, even touched on the use of traditional medicine. The grandmother did not like the orthodox medicine because the pills made her sick. When we visited she was cooking some leaves from the bush for her fever and she said that these worked very well. However, she did not see an herbalist and knew what to use herself. This use of traditional practice when the modern approach does not work was also seen at the bonesetter’s clinic. One man did not want metal inserted in his arm another could not get placed in a modern clinic. In this scientific age the traditional herbalists/bonesetters are using modern x-rays to do their work and it seems to be working well. We also visited the traditional birth attendant (TBA). The one we visited happened to be trained and served the larger community including Otinibi. She was trained in 1996 and before that she just used her experiences and teachings from elders to do her work. We learned that in many cases traditional medicine is reverted to for reasons of proximity, emergency, and convenience. The vast majority of the Otinibi community used the modern medicine and ‘knew’ that it was the best option. The father we interviewed even went to the chemist (pharmacy) to pick up headache medication for his wife. When I asked Elkanne what he thought about traditional medicine he quickly responded that he only used the Danfa Clinic, but why not? His father worked at the Clinic and the parental influence is very strong in Otinibi. The parents we interviewed would take their children first to the clinic before themselves.
Our Recommendations
We observed a number of open pits and stagnant water sources. There was an old open well that had accumulated a disgusting degree of trash, fecal matter, and god knows what else. We recommended that these holes be filled in to reduce injury risk and mosquito breeding. Our next recommendation was for a separation of trash and regular removal. We also saw a positive in starting a composting project. This could help with the community’s subsistence farming. Since it was the rainy season many homes had closed windows and poor ventilation. For this we recommended screens or mosquito nets on the windows to keep out pests and provide ventilation. For nutrition we recommended maybe introducing beans to be grown and eaten as a source of protein. We also recommended that the people eat what they grow. A number of those interviewed grew vegetables and other foods, but only to sell. Eating the local fruits would also help the nutrition of the community. These were just the small ways that we saw to improve the community health. I would say that the community was for the most part healthy and just needed to act on some simple measures to ensure a greater wellbeing. I also noticed that there was a great lack of emergency transportation. There was none except for the local vehicles. I saw people hurriedly carrying sick people into the clinic, the TBA talked of childbirth emergencies with no transport, I have seen and heard this before – investing in an ambulance may help.
While in Danfa/ Otinibi we had number of delicious Ghanaian dishes:
Palava Sauce (spinachy) and Boiled Cassava
Groundnut Soup with Chicken and Rice Balls
We saw a scorpion! In Ghana they are seen as very evil creatures and are the evil-doers of witches. This one was caught in the gutter and after we all took our pictures and left was probably smashed to a pulp. Scorpions are hated with the passion of a million fires in Ghana.
Index of blog post series on Ghana.
Alex B. Hill 