HEALTHCARE IN THE DEVELOPING WORLD: GHANA Archives – Hire Nurses Blog
Akwaaba! In Ghana, the word akwaaba is widely used as a welcoming greeting. Welcome to Ghana, and a look at the state of healthcare in this developing nation. In this series, I will be describing different facets of today’s healthcare system in Ghana, from the small rural village clinic to the most prestigious teaching hospital in the country. I hope you enjoy a glimpse into this important part of life in Ghana.
Part 2: The Challenge of Providing Healthcare in a Remote Village
Lake Volta, the largest man-made lake in the world, was formed by damming the mighty Volta River. This hydroelectric plant provides the country’s electricity.
Today we’re moving from Ghana’s Eastern Region north of the capital city of Accra, to the Volta Region. The Volta Region lies in the eastern-most part of Ghana along Lake Volta and the Volta River, and shares a border with Togo, the neighboring country east of Ghana. Dogbekope village is near the Togo border, close to the ocean to the south, and bordered on the west by the Keta Lagoon. The village was founded by my husband’s great-great grandfather during slavery times, and was intentionally situated in a remote and hidden area so that residents would be safe from capture. That was a brilliant idea at the time, but in modern times the seclusion of the village causes some real challenges to healthcare. To arrive at the village by the shortest route requires a four-wheel drive vehicle, or a motorbike, or you’ll quickly be stuck in deep sand.
The approach to the village along the sandy shore of the Keta Lagoon, a huge saline lake that provides one of the main means of income for this region – harvesting salt.
Daily life for Dogbekope’s approximately one thousand residents is a struggle, in part due to the lack of sustainable employment. Salt is harvested only during the four-month dry season; the remaining eight months of the year are spent growing a few crops that can be raised in the sandy, slightly salty soil. The other major source of income is weaving, a traditional craft of great beauty. Like many handicrafts, the time spent and the resulting work of art does not earn the craftsperson much by way of income. Other people in the village earn a limited livelihood selling prepared foods, or maintain small businesses like “drinking spots” or little dry goods stores. The simple lack of disposable income provides another challenge to helping people in need of healthcare.
Dogbekope has a small “community-based health provider service” – the lowest level of organized healthcare in Ghana. The clinic was founded by Joseph Waklatsi, a Ghanaian ex-patriot physician residing in the United States, whose family comes from the village, funded by donations and staffed by American volunteers. Some years ago, the government picked up the project and now staffs the clinic with two Community Health Officers. I was lucky enough to be able to interview Philimon Ametorwodufia on a slow morning at the clinic.
Mr. Ametorwodufia, a trained Community Health Officer (the equivalent of a nurse practitioner in the U.S.), explained Ghana’s healthcare system, “There are different levels of healthcare. We’re a ‘level A’ – meaning our clinic is staffed by nurses and by law can only treat certain illnesses. To become a ‘level B1’ would involve expanding the clinic to provide a labor and delivery room, another examination room, and a small laboratory for basic lab tests. Then the government would give us more support through more highly trained staff and allow us to prescribe additional medications.”
Bulletin board showing the major public health concerns the clinic watches out for.
At just shy of three months at the clinic, Mr. Ametorwodufia is already feeling the frustration of knowing how to diagnose and treat common illnesses but being prevented from doing so by government regulations. “We are really a monitoring site for highly contagious public health issues like cholera, yellow fever, and Ebola. If someone comes in with symptoms of one of these, or other, severe diseases, our protocol is to notify the health officer at the closest hospital and they are supposed to send someone out immediately to rule out the presence of these illnesses. Last week someone came in with a possible measles infection. We followed protocol but the disease control officer never showed up. Fortunately, it wasn’t measles and the person recovered.” As mentioned previously, getting in and out of Dogbekope is a challenge – so imagine being severely ill and needing to be transported on the back of a motorbike for about an hour’s journey to the hospital! Yet this is what would happen if a person had a communicable disease that couldn’t be treated in-house.
Pregnant women face a similar transportation issue when they go into labor. If they choose to deliver at a hospital, they have to ride on a motorbike behind the driver, with their support person in back of them – yes, that’s right, three people on a motorbike bumping over rough roads. “It happens frequently that the woman delivers the baby on the side of the road – she doesn’t reach medical assistance in time,” shared Mr. Ametorwodufia. “Most women in the village will deliver their baby at home with the services of one of the elder women in the village as midwife. If we could expand the clinic to include a labor and delivery room, and a qualified midwife could live onsite, it would be of great benefit to the women in the village.”
Chart of government-supplied vaccines and vitamins for children
The clinic provides well-baby checkups and childhood immunizations, the vaccine provided by the United States and distributed by the Ghana Health Service. Babies receive a complete round of vaccinations starting at birth up to 11 years of age – around ten different immunizations plus Vitamin A and an iodine supplement. All the immunizations are provided free of charge. The clinic staff also go into the schools to assess the welfare and health of the children, as well as making home visits to check on the elderly in the community.
There have been no confirmed cases of Ebola in Ghana, but health officials continue to be vigilant.
Paying for services at the clinic is one of the main barriers to village residents seeking out medical care, even when seriously ill. The clinic has not yet qualified to accept the Ghana national health insurance, so all services are “cash and carry.” The minimal cost of 6 Ghana cedis for a consultation and 12 Ghana cedis for any medication (a total of about five U.S. dollars at today’s exchange rate) may be all the patient has earned that day – money that will go to feed the family. Mr. Ametorwodufia explained that even with health insurance, the cost would only go down a few Ghana cedis and would still be prohibitive for most people. “As an example, if a person has malaria, we can treat the beginning symptoms to prevent the illness becoming more severe. But if the patient won’t come to the clinic, and the malaria progresses to the acute stage, we can’t treat it and the patient has to be transported to the hospital for treatment.”
Health initiatives to protect people from the effects of climate change.
Traditional healing methods, including the use of local medicinal plants, is another avenue of treatment some will seek out. The interplay between traditional healing and “western” medicine is a fascinating subject and one that I will explore in future articles.
You can help support the work of this little village clinic in several ways:
• Donate over the counter medications such as ibuprofen, aspirin, paracetamol (Tylenol and generics), antibiotic ointment, eye drops, antacid, diarrhea control pills, diphenhydramine (Benadryl and generics) or other antihistamines such as chlorphenamine or related meds (Dimetapp, etc.), cough and cold meds (including children’s liquids if available) as well as multivitamin and mineral supplements for adults and children.
• Donations of antibiotics, specifically amoxicillin, ciprofloxacillin and flucloxacillin and antimalarial medications Artemether/Lumefantrine and Artesunate/Amodiaquine (medications prescribed for uncomplicated malaria) are also greatly needed. Donated medications can be given out to patients free of charge, whereas the government-supplied medications incur a charge that most patients cannot afford.
• Basic medical supplies like good quality stethoscopes and blood pressure cuffs – even used ones – can be put to good use. The clinic is also greatly in need of items like digital thermometers, surgical gloves, disposable examination gloves, gauze rolls and bandages, cotton, adhesive tape, and face masks.
• If your hospital or clinic is updating your equipment, particularly basic lab equipment, consider donating your used items (if in good working order).
• Volunteer your time if you’re a licensed practitioner.
A project to raise funds to expand the clinic is in the planning stages. If you’d like to be kept informed about this project, please contact me at email@example.com . Also, if you’re able to donate any of the above-mentioned items, please contact me for an address to send it to.
As part of the effort to improve healthcare in Dogbekope, Batiks for Life is donating 10% of income from sales of our scrubs toward medications and the building fund. Please visit our online shop at www.batiksforlife.com/shop to order.
ABOUT THE AUTHOR:
Sara Corry lives in Aburi, Eastern Region, Ghana. She owns a US-registered business, Batiks for Life LLC (www.batiksforlife.com) which manufactures medical scrubs using the traditional batik fabric of Ghana. These uniquely beautiful scrubs have earned praise for their design, comfort and quality and are 100% made in Ghana by seamstresses and tailors earning a living wage. She is happy to receive orders through the online shop, and is branching out into custom orders and wholesale. She and her partner have recently begun a campaign to raise funds to expand a village health clinic, and 10% of income from sales of Batiks for Life products supports this effort. Sara is an executive director and featured author for the sustainable fashion website “Trusted Clothes” (http://www.trustedclothes.com/) and also blogs through the Batiks for Life website as well as her personal blog “Daily Life in Ghana” (http://www.dailylifeinghana.wordpress.com/) . She has traveled extensively through all but the most western section of Ghana. She may be reached by email at firstname.lastname@example.org