snapshot of health in ghana

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.

two voltas, one ghana, three africas

The past two Thursdays we have traveled to the Volta region – one trip to witness tradition, the other to indulge in tourism. Both were early morning trips to the furthest eastern region of Ghana. The region is the major Ewe region of Ghana, it was decided by the British to slice Ewe-land in two after the defeat of the Germans in World War I. The major ethnic group and the remainder of Ewe-land is in Togo. The British were greedy. The route we took was a toll road, no speed bumps or potholes (relatively smooth ride) straight across from Accra into Togo. I couldn’t sleep and our guide accompanying us told us before we left that in the Volta Region we would see things that we may have only dreamed about. Everyone tells us that whenever we travel we will see something so different. This really say something for the small country of Ghana, that just traveling to a different corner of the country can be such a unique experience – this says something more for Africa, since Ghana is one of its smaller countries.

27 May 2007
As we left the Accra area we passed many huge, mansion style, western homes built far from the city’s busy, crowded and slightly imposing character. These palatial (check that out mom) homes seemed to present a city of their own set above the rest. Further out was the land of big trucks and truck stops. Rows upon rows upon rows of trucks; tanker, flatbed, carrier, produce, waiting for cargo filled a long stretch of road. Even further from the city everything turned to green. Oh so green, we passed a lush landscape dotted with trees and two-person high mounds of red dirt – this was the kingdom of the termites. The mountains in the distance were highlighted by the rainclouds overhead. After crossing the man-made River Volta we were finally in the Volta Region. Here we were treated to a very different ride – massive potholes. The bus zigzagged the roadway to avoid the potholes and crevasses – it felt as if we were in a Star Wars asteroid field. It seems that the government does not have much to do with the region.

We first went to visit the local chief of the village of Klikor, which is one of the important settlements of the Ewe people. The chief has ruled over a kingdom that is over 400 years old. The chief commented on this related to development. He noted that they were much older than the US, but that they were less than one-tenth as developed. He orated a great history of his people, village, and how they eventually settled in Klikor. It was almost like living the reality of so many books that I have read. He also gave us a history of Ford and what he did for the US. He mentioned that everyone here (Klikor) had benefitted from the Ford Foundation, how I am not sure. But he did make a great point that President Ford was not one of the wealthiest men, but he left a great deal to charity and his foundation. The chief went on to tell us what to tell our friends back home, but instead jumped into a lecture on the US and Iraq. This is about the fourth such lecture that I have experienced on this trip. He made an important note that even the ‘smallest mistake of the US’ has an impact around the world. One of the students later commented on how “Africa-esk” that experience was – this is Africa!

We then traveled to another part of the village to experience traditional African religious practices. We were to see a ritual possession ceremony. Before the ceremony we were treated to the most simple, but delicious meal that I have had yet -the best tuna that I have ever eaten. We changed into the proper dress – a wrapped cloth. We were welcomed with drum and song and given kola nut and whiter clay as a sign of welcome along with a small, narrow, triple shot coconut cup of dry gin which tantalized the throat and assisted with the dancing later.

The possession had already begun and the high priestess already conveying messages from the sea-god. I have complete respect for the traditions of the village, but throughout the ceremony I could not help but think that this was a performance. I think Kyle put it best during our discussion of the ceremony, “It is like a choir performance, we may never understand what is happening, but it is still a performance.” The performers exchanged knowing looks and laughs and my thoughts were solidified. I mean no disrespect, and I really think that our experience would have been different had we been embedded in a village and taken part in the ceremony firsthand.

The rains had come as we ate and continued throughout the day. We left and our bus navigated the narrow ‘roads’ of the village where bikes and motorcycles dominate the streets. The typical houses were mud and thatch, the wealthy had cinder block houses. We returned home in the growing rainstorm.

31 May 2007
Memorial day spent in Ghana, I hope the water is not too cold for putting the dock in. This is the first time that I have really thought of home. It is plenty warm here to put a dock in any day.

This was another early morning headed back to the Volta Region to see the waterfalls. We took a much different route than before since the falls are about 6 hours drive from Accra: three hours to Volta and then three hours more in Volta. This time as we crossed the Volta River, we stopped at a riverfront hotel. This hotel was very nice, a prime place to spot an Obrooni. There were none, but there were monkeys and exotic birds in cages. There were speedboats and jet skis to be rented and a very nice pool to swim in. We had entered the second Volta. We crossed the river this time by way of a nice large bridge. and the roads showed that the government had not neglected this tourist favorable side of Volta. We arrived at the falls and met our guide. He took us on the 40 minute walk to the falls and showed us some of the local trees and wildlife as we went. He told us that behind the mountain pictured was Togo, so close.

We journeyed through the beautiful wilderness and finally heard the sound of the falls and saw its wonder. The falls were amazing, the tallest in all of West Africa. The fruit bats covered the mountain side and screeched and sprang to life as the group screamed and swam in the falls below. It was incredible to see. I wish that I had not forgotten my swim trunks. Next time.

These experiences brought to life my thoughts that there are two Voltas in Ghana. We saw them both and I guess if you can bring the government tourist money then you will have paved roads, nice hotels, and the access to basic infrastructure like electricity. This also makes me think of George Packer’s chapter in The Village of Waiting titled ‘Three Africas.’ I think it is very interesting that what he explains in the pages of his book, I have seen in my limited African experience. I saw the ‘village’ Africa while traveling rural Uganda, the ‘tourist’ Africa in the Queen Elizabeth National Park of Uganda and the waterfalls of Volta, and the new, growing, struggling Africa in the booming city of Accra, Ghana. Full of new technology, development, and thriving with entrepreneurs. These three Africas can be seen on any travel to Africa, but most of the time these three very different Africas are only seen one at a time. Does that mean that I have seen the true and complete Africa? I think not, I have only traveled to three countries in Africa – there is so much more to see!

Index of blog post series on Ghana.

weekend of the obruni

This past weekend is when we began our intense American weekend. This was when we did the most Obrooni things and par-took in the delights and desires of an Obrooni. When you think of everything that a visiting Obrooni might do, we did it. Every place where an Obrooni was most comfortable, we went.

We started out by going to the shopping mall. Yes, a shopping mall It didn’t contain much that was amazing, but it was close enough to home for most of the area Obroonis to shop there. The shopping mall was tucked away, hidden almost, in the opulent, lavish, private homes of the wealthy – and Obroonis. There was a liquor store, jewlery store, ice cream, fedex, small grocery store, some beauty salons, offices, and a very nice internet cafe. It was easy to tell that Obroonis from the area and those working in Ghana frequented the shopping mall. It was easy to tell that these Obroonis flocked there for their daily needs, but it so much easier to get what you need on the street. This is also where I saw my first ‘real’ parking lot in Ghana.

We did some shopping and haggling in the ‘Center for National Culture’ and headed back to the hostle to eat some lunch.
It was a big meager and a bit Obrooni of us, but still good. We ended the eating session with some FanChoco, it is a plastic pouch, like the water, of frozen chocolate milk – so good during a hot day. A few of us decided to go for a run for the first time in Ghana. So far the only people running that I have seen are either training for soccer or are late for something. As we ran the back streets behind our hostel, people called out, “Obrooni, what are you doing?” Children ran to the street and callled ‘Obrooni’ to us. The children lined the road clapping, cheering, and chanting, ‘Obrooni.’ It was almost as if I was in a high school cross country race again. The best was the taxis who honked at us to see if we wanted a ride. No, just some silly Obroonis who want their excerise. It must really make no sense to most Ghanaians since most of their daily lives and jobs are excerise. Here they can’t choose when to excercise or not, it is run or just stop.

We had heard of a great recommended restaurant called Afrikiko and decided to go there for dinner, since there was also music. But we arrived and all the lights were off, it looked quite shady so we headed to another recommended place called ‘Home Touch.’ On the way to Home Touch, our taxi passed the new, under-construction american embassy. It was so disgustingly huge and unnecessarily gigantic. The US has pulled it foreign aid from Ghana, so why does it seek such an imposing presence? The compund was massive, many storied almost like a hotel, multpile gates, and numerous secuirty cameras. I couldn’t believe the extent of the new embassy. We arrived and got a big table and at the start of the evening we were the only people in the place. We drank and ate goat and fufu in a light soup. I am not sure what light soup means because my soup was so hot that my lips and throat burned with goodness afterwards. Some of the girls in our group sang with the live band (quite Obrooni) and made fools of themselves, but it was a great time. When we were given our bill it was about 200,000 cedis too much and we thought we were getting jipped, but oh well.

We had the rest of the weekend plus Friday off since we were traveling to the far eastern region of Volta on Sunday. We woke up early, for some reason unknown to me, for breakfast on Friday because some of the girls were picking up dresses made in Osu and some of the other girls were getting their hair braided. Most people returned to their beds to regain some lost sleep – which I hear is impossible to do, but I did likewise. I slept for a really long time and did some more reading, finishing The Village of Waiting. We then met up with hte group at Frankie’s to go out and Francis joined us. We first went to Epo’s bar with Francis and met and had some drinks. While we were there a big volunteer group from England arrived and we chatted it up. I talked to a girl who was stationed in a very rural village in the north of Ghana and found out that each person was stationed far off in a different area. The English people, with their beautiful accents, were headed to a nightclub called ‘Bliss,’ so we decided to tag along. It seems that no one, no taxi driver or otherwise, knows of Bliss or where it is. Finally we found a taxi driver who knew the place and headed there. We arrived and were treated to the most Western style bar and club that I have seen yet. It was full of Obroonis – American and English – no wonder no one had heard of the place.

Saturday we all slept in after the night of clubbing. I missed breakfast since I slept too late. Most of us stayed in our rooms sleeping, reading, or just hanging out. I didn’t emerge until 2pm and didn’t eat until very late. We all went in waves to the internet cafe and talked in the courtyard about our experiences in Ghana so far. What an Obrooni weekend – in style, food, company, experience, and habit. We ended up having a great Ghanaian meal at Cez Arfique, but otherwise so Obrooni.

Index of blog post series on Ghana.