Kumasi – Alex B. Hill

when in ghana. . .

This is a series of post that I wrote while completing an MSU Study Abroad program on “Disparities in Health Care” in Ghana. Our group was based in Accra at the University of Ghana, Legon and we stayed in a hostel in Shiashie. We traveled often: Volta Region, village of Klikor, Kakum National Forest, Volta Dam, Cape Coast, Kumasi, and Osu was a usual hangout. The posts are all pictures and reflections during that 6 week program in Ghana. The first post is a research paper I completed for a class about “development” in Ghana.

i. The Quest for Development: Aid to the Rescue in Ghana
ii. off to the continent of my dreams
In Ghana:
1. something you can taste
2. water by day, apples by night
3. for the love of america
4. scenery and speed bumps
5. aljazeera, acrobats, and aloe
6. imperialist footprints: the development story from the inside
7. the quest for the west
8. what is so important about ethnicity?
9. the value is the same
10. weekend of the obrooni [obruni]
11. two voltas, one ghana, three africas
12. the nature of africa: rhythm and socialism
13. image of america, the blinding lights
14. inside africa
15. definition of development
16. . . . keep your promise
17. the chinese influence
18. snapshot of health in ghana
19. a mixture of black, white, red
20. the longest driveway
21. when in ghana
Returned:
22. when not in ghana. . .
23. the land of culture, africa
24. the caramel apple of globalization
25. cynicism from a jaded summer
26. the crouching tiger and the curse of black gold
27. rastafarian confusion

snapshot of health in ghana

Health, On the Ground

We are now a week into our second course of out study abroad program, studying the disparities of the Ghanaian healthcare system. These disparitites range from Ghana to the US, urban to rural, and ever North to South. We have seen and learned about a number of different healthcare situations in Ghana. Since my interest is in access to basic healthcare I have been watching health clinics as we traveled around for the first 4 weeks and I have been trying to understand how the healthcare system worked, now all that I have observed is making more sense.

The Statistics
– one third of the 138 districts have no hospital
– high maternal mortality rate (hemorrage & infection)
– beyond the capital the road system is poor
– 40% of population is covered by the national insurance
– life expectancy is 57 (this has fallen with the emergence of HIV/AIDS)
– healthcare is geographically, financially, and culturally inaccessable

The key problem in Ghana is figuring out where the divide should be joined between traditional and western medicine. What is more interesting is the integration of traditional medicine into the very western Ghanaian health system. I noticed from my pre-healthcare course observations that there is a large number of missionary clinics, government hospitals, pharmacies, and other private health service centers in the Accra area. As we traveled from Cape Coast, Volta Region, and Kumasi I noticed that there was a lesser degree of healthcare services advertised or offered. Why was there such a change from the urban to rural was my first question. Even more so why was there such a disparity between the other regions and the Volta Region of Ewe people?

7 June 2007

Our first visit of the health systems in Ghana was to a health clinic and research center that was solely focused on using traditional medicines and herbs for cures of ailments. It was very interesting to observe the research being conducted and see that they were also running a full health clinic with their findings. The center claimed to have WHO (World Health Organization) funding, but I am not sure if that is true anymore. While there we met some students from the US who were interning at the center for the summer. This is a direct linkage between the traditional and western methods of medicine. This also brings up the issue of intellectual property rights – do the communities that the center learns from benefit from its revenue? Sure the health clinic, but otherwise? This is a reason that the center’s director gave for not partnering with large pharmaceutical companies – to not lose IP rights.

From there we went to the Mampong district outside of Accra to view the structure of the health systems and network of regional health services. We first visited the regional administration offices and talked with the head nurses. They gave us a very well run and organizaed outlook on healthcare in Ghana. At the offices there was also a counseling and testing clinic for HIV/AIDS and a peer educator class taking place. Here we learned that USAID (United States Agency for International Development) provided food rations for new mothers and mothers with malnourished children. I asked if this was true at all regional districts. The answer was yes, but I wonder if all the regions are as well established as Mampong. We then went to visit the regional hospital. It was a large, modern building, not very dissimilar from what you would find in America or Europe. But, there were obvious differences in the developed nature of the hospital. It was a nice hospital, but not one that I would want to stay in. We were given a tour of the entire premises and had a near-death experience in the elevator. Twenty plus people in an old hospital elevator in Ghana makes for exciting times. The elevator descended with the help of our weight and gravity – there was a loud bang as we hit the safety catch – there were still three floors to fall. The head nurse was not very keen on what to do next, but eventually we all climbed out from the gap left between the two floors to the wondering faces of what seemed like the entire hospital staff. Its the stairs from now on.
There seems to be a very good system of healthcare in the relatively developed areas of Ghana, but as for the villages I cannot say. It seems that we have visited mostly well put together centers and clinics. This made me think of the situation in Uganda, where it is the private and mission clinics that have all the supplies and the government run centers have absolutely nothing – very different.

At the Mampong regional administrative offices we learned that in many villages where there is no clinic or government hospital there is a nurse that lives in the community and is charged with the health of that community. However, I cannot speak to the degree of training or equipment that these community nurses have. This speaks to the obvious disparity between the urban and rural environments. There is not as much access to healthcare in the rural areas and so I wonder how much access there is in much of the rural North of Ghana? How many people do not have access?

11-13 June 2007
Some of the issues brought up in our classroom lectures about the health systems in Ghana relate to money. Not everything is covered and so some people cannot pay for access to services. There is bribery in medicine, we have not experienced this, but I do not doubt it. The basic insurance policy in Ghana costs about 72,000 cedis a year, this may not seem like a lot to ‘developed’ countries, but to a Ghanaian this could mean a great deal. In its health development, Ghana is still working on eradicating polio and guinea worm – even in metropolitian areas. Sanitation is a big problem. “The world is my toilet,” has become a joking phrase among the males in our group. If you are a male you can urinate just about anywhere, except where it says, “do not urinate here!” However, you still see people urinate by those signs. Sewage drains have stangant water and often do not drain anywhere. Trash is not collected and is often burned by the roadside. This reminded of Uganda where trash is just thrown out the window. In Kampala you cannot get away from the smell of burning trash, and there are not even drainage ditches.

Another issue brought up was that of ‘assembly line medicine.’ In Ghana there is such a high number of out patients (40% due to malaria) that the health workers often diagnos based on perception, not based on evidence. The issue of traditional and modern medicine is also a hotly contested topic. The health worker crisis in Africa seems to have been circumvented slightly in Ghana. Ghana has included traditional birth attendants in their health system and has just set up a new council for traditonal medical healers to have their say. The most fatal health issue in Ghana now is maternal motrality. Why? Good question, Ghana is ery developed in its understanding of health practices and so it makes no sense whatsoever that a mother should die due to complications of childbirth.

We next traveled to Ashesi University, a private, liberal arts university in Ghana (the most liberal in all of Africa, supposedly). Here we met a Fulbright fellow and a former fellow who is a profesor at Eastern Michigan University. Here we talked about the ‘brain drain’ and new ideas for Ghana’s health system. Currently a physician is in charge of managing the health center, but this means that often the physician has no idea how to manage and makes the staff unhappy and then does not practice medicine because he or she is too busy managing the center. The professor from EMU was working on publishing a study to help change this and introduce education for health managers. The incentives for staying in the country to work are minimal, but inticing. If you work in the Ministry of Health (MOH), then you can be sponsored to increase education and degree. The professor also talked of how Africa, “gets under your skin, you keep coming back.” It really made sense to me and I really don’t want to leave.

13 June 2007

Today we visited the Korle Bu hospital, the best government hospital in all of Ghana. We were not able to tour the main clinic becuase we arrived late, but we did get a quick tour of the Department of Child Health. It was a very nice center, as you can tell from the pictures. This was again an amazing compund that constituted a village in itself. It was obvious that this center must receive a large amount of the government funding for health. There were a number of different center, housing for doctors and nurses, a bank, pharmacy, and a teaching hospital for the University of Ghana. Hopefully we can return later and get a tour of the main clinic to see how things are run there.

The recommended health center for the MSU program students, if they are to fall ill on the trip is Nyaho Clinic. It is a private center tucked away in a random area of Accra. We have had a few students go there, but I have not seen for myself the interior. I have heard it is very nice and Ghanaians in the health profession know it as a nice and expensive clinic.

So far most of the health systems we have seen are very well established and well run and seem to be in great condition. We have not seen the failings of the Ghanaian health systems and the picture for now seems very rosy. I have seen the many mission, private, and government hospitals and clinics in the fairly ‘developed’ regions of Ghana. What I have not seen is the lack of healthcare like I saw so vividly in Uganda. The EMU professor at Ashesi University told us stories of his experiences with health in Ghana. He told stories of overrun rural clinics, a family’s inability to pay for lifesaving medication, the long distances traveled wo receive attention when it is too late, the sheer numbers of people who just do not have access to basic healthcare. This is where I feel we should be, this is where it would make sense to me, this is where we can make a difference. We will now be leaving for the village of Otibini near Danfa to do a community health assessment. I think here is where we will get to feel the village life and true health crisis.

Index of blog post series on Ghana.

. . . keep your promise!

Development, On the Ground

Congratulations big sister Molly on graduating from Kettering University! Now the lifelong education starts which no school or curriculum can offer.

At the end of this week we traveled to the Ashanti Region to visit Kumasi and some of the surrounding villages. We began our travels just as the G8 Summit was ending and the news has been all over the importance this summit held for Africa and Ghana.

8 June 2007
The eggs and toast constant has finally been broken with some glorious french toast – syrup, cinnamon, and a delightful change. No one in our group has ever appreciated or enjoyed french toast as much as we did that morning. The heat and sun have also returned from an absence. It has been a rainy and overcast week, but the sun emerged to greet us. Before hitting the road we stopped at the Forex to exchange some money. Aljazeera News was playing and the topic was the G8 keeping promises to African aid. They reported that $25 million is sent to Africa in aid each year, but that there is an $8 million shortfall. During this summit the G8 pledged to give $60 million to fight HIV/AIDS, TB, and malaria in Africa. Will these be promises kept?

We hit the road for the 5 hour trek to Kumasi. It would have been a very boring and tiresome ride, but I had my book and BBC radio to keep me company. Top stories included the role of the G8 in keeping promises and African nations also keeping promises, J.A. Kufor, President of Ghana, speaking on behalf of the African Union as chairman asking for G8 commitment, and a stunning story about female genital mutilation (FGM) in Cameroon – a boy ran from home with his younger sister to protest and to protect her from the harmful practice. Their father then went to the village council to plead with them to abandon the practice as it had taken his son and daughter away from him. The village then banned the practice and the children returned home knowing that now many girls would not have to suffer FGM. I had also purchased a novel from the University bookstore, The Last Duty. The book is about the Nigerian Civil War of 1964, which I knew nothing about in all of my studies of Nigeria. The book tells of the war and its effect from six different people’s views, all six are linked, and all six represent a different side of the story – except for the rebel view.

Our first stop before Kumasi was Bonwire village where we visited a Kente cloth weaving shop. We were mobbed by children here and people trying to get us to buy their stuff. It must have been one of those tourist common spots. It was interesting to see all the Kente cloth and Eric, out bus driver, helped me bargain for a Kente cloth tie – very awesome. Some of the sellers were very persistent. One, I forgot his name, stuck with me and haggled me for a long while. He tried to sell me bookmarks, then helped his friends sell me stuff, then asked for money for his grandmother, sister, and himself – the story always changes.

Gracious Living Hostel was situated on a road that I knew well. It was the typical African roads that I had come to know from Uganda and feel always in my hindquarters – not a smooth surface to be found, dust kicked in the air blinding all, and a tense body ready for the next impact. At the hostel there was some trouble with rooms and so we were a bit crowded in the beds, but hey this is Africa, we can deal. Some of us played a card game called ‘peanuts,’ but which I later found out was the game I knew as ‘nertz.’ It reminded me of some great afternoons with Grandpa.

9 June 2007
We began our day with a nice breakfast and went to the Kejeta Market in Kumasi. This is the largest open air market (in the world? in Ghana?). The market was much like Makola market, but much bigger and crazier. It was also much more fast paced and there were narrower alleyways and more grabby stall owners, there was just so much more happening. In the market is where I also witnessed the ‘travels of a t-shirt in the global economy.’ There were many stands sporting the latest Western fashions, but these were obvious imports. There were large groups of people sorting slacks, jeans, and t-shirts from piles of clothes imported from the ‘developed’ world.

Afterwards we headed to the village of Kurofuforum where we learned how brass figurines are made. It is such a long and tedious process with so many steps. It gave us a new appreciation of the artwork. The man showing and teaching us had scars all over his knees and arms and could pick just about anything directly out of the fire – so calloused and hardened by his work. We then went to Bosumtwi Lake. Here we were accompanied by local fishermen on their fishing boats to swim in the lake. The fishing boats are comprised of half of a tree log, that is it. It was a very good workout to paddle all the way to the middle and a joy to swim in the, what felt like, 90 degree water. What a great experience.

10 June 2007
We began today by stopping at an Adinkra village to see how cloth is stamped. We bought a cloth and witnessed some of our professor’s skill at arguing and bargaining in Twi to get a good price. We then all took turns stamping the cloth to take back with us as a reminder of our trip.

We happened to pass the regional bottling station for Coca-Cola in Kumasi. Coca-Cola is the drink of Ghana. It holds about 90% of the soda industry here against Pepsi.

We visited the Royal Court and Palace Museum of the Asantehene, the ruler of Asanteland in the Ashanti Region. No pictures were allowed and the outrageous price for foreigners followed us into the compound. We were first subjected to a propaganda video about the Asante people. The video claimed that the Asante were peace loving people, yet if you look at their history it is clearly evident that they were quite to use violence and were very aggressive people who instigated many conflicts. It was very interesting to learn about the history of the Asante people from the very place where their kingdom resides. It was especially interesting to learn directly about a people that I have studied so much.

On the way back to Accra from Kumasi, BBC doesn’t come in until you get closer to the greater Accra region, I finished my book and was finally able to listen on the BBC to debates about the G8 summit from an African’s perspective as callers from Tanzania and expats from other parts of the world voiced their opinions and reactions. Another interesting story was about the Burma Boys of Nigeria who fought in WWI for the British in Burma. The story was of colonized Nigerians fighting in Burma and being addressed by the Japanese fighters in perfect Hausa, one of the major language groups of northern Nigeria.

This weekend we have seen the greatness of the very western oriented Kumasi and the kingdom of the Asnatehene. We were able to see part of the reason that the British gave Ghana the colonial name of the Gold Coast from the wealth of the Asnate. We have experienced a region deeply rooted in tradition, powerful traditional rulers, and great wars with imperialist countries.

On the way to Kumasi our professor commented on how much has changed since the last year. She noted that there was so much money flowing into the country now as opposed to just a year ago. Is the G8 keeping promises in Ghana? we have passed so many road improvement projects that it is almost as if I am back in Michigan and experiencing the common ‘summer of orange barrels.’ Except that there is no such thing as orange barrels here, there is just random stuff in the road to divert traffic. The money and aid flowing into Ghana makes me wonder if there are any G8 promises not being kept here. The promises for keeping aid promises by G8 countries is rebuttled by the G8 calling for promises to be kept for good governance in Africa, and is again clashed with the argument by many African intellectuals to have foreign countries leave ‘development’ to the Africans.

Check for new pictures of drumming and the Peace Corps in older posts.

Index of blog post series on Ghana.