Surviving Perpetual Meetings

The amount of meetings I go to is crazy. Not only is it usually last minute and lengthy, it is mostly boring. I'm not used to Ghanaian style presenting, I can't maintain my attention as it sometimes takes hours to explain a simple concept. We spent 30 minutes on one slide recently, it had about 2 bullet points on it. On the plus side, the descriptive stories and anecdotes can be entertaining, just after 5 hours I'm usually happy to skip some of the finer details...

So my last meeting was a training session that I have attended at least 4 times already, but I'm more there for 'support' or just 'representing' the organisation. So I amused myself. I did a small study, with the results shown in the following picture;

So in summary;
the presenter took a call while presenting 3 times
the presenter wasn't listening once (this is pretty impressive, must have been an off day)
someone falls asleep: 0. awww, a rarity too, but I was up the front and I'm sure a sneaky nap was had without me seeing. It's the whole point!
the power went out twice (which means projector goes off)
twice I laughed when nobody else was laughing, and sadly, three times everyone laughed but me, I had no idea what the joke was...
only five times did we defer from the actual topic of the training for at least 15 minutes. This is probably a record, especially for the presenters as they love a good story, laugh and the sound of their own voice (there's always one presenter...isn't there!)
I guess it was a small training, because only 7 people answered their phone in the training 'quietly'... and by quietly I mean I could hear the conversation, or I could see them ducking under their chair, or leaning back, or looking up so their voice traveled upwards, and therefore was 'not' disrupting.... that's a personal favourite trait here. The quiet answer of the phone....
We started 2 hours late which wasn't too bad, and the last person arrived 3 hours late which was pretty good too. So all in all, I managed to amuse myself, and it was a good meeting.

Giving

I may sound skeptical about development work; I've had many generous offers from people at home to help me 'make a difference' here that I have refused, and possibly offended people. I have just come from a meeting that has provided the perfect example for you as to why I cannot just take money or items and contribute to 'developing' Ghana...

A well meaning NGO donated $200K for supplies to a very poor district for a new maternal health program. Four years later the supplies are collecting dust in the warehouse. Why? The district still has only two midwives - who were last trained in 1995.

A perfect example of how money can be mis-spent. and quickly. My meeting is about how to identify needs, and where to be most effective. Sometimes with so many problems, so many shortages, it is hard to prioritise and programs can be directed in the wrong area (as shown). This new move is positive, and needed, a good step forward.

Back to it!

What do you want me to do with that?

Community Spirit

The most impressive thing I have seen over the year in Ghana has been the hard work of the community members for the benefit of their friends, family and peers. The most impressive program I have witnessed is called Community Case Management (CCM). The program is a Ghana Health Service program, with funding from UNICEF. It focuses on the biggest childhood killers in Ghana; 1. Malaria, 2. Diarrhoea and 3. Pneumonia. These are so common in children under 5 that this one intervention, if implemented universally, would reduce the number of under 5 deaths by 63%.

It is a program that is used in many countries, with the difference in Ghana being that the people running the program, assessing the children, going from house to house, being on call 24/7, and administering the treatment are all community volunteers. The community can nominate 2 people, who are then trained and equipped with educational cards, medications and reporting forms.

These volunteers are mostly women, which in the rural areas, means illiterate with no, or very little education. The volunteers diagnose and treat children using the skills taught to them in annual training sessions, a challenge in itself when you are trying to educate without the use of written tools. Role plays are a large part of the training, yet I never quite understand how the volunteers manage to remember the amount of information they do.

Volunteers attending training. Often with their own children. They are in charge of their supplies - in the white boxes, they carry these around on their heads, or if they are lucky, on a bicycle.

The main thing about the program, I have learnt, is that it increases the use of health services by poor children. Due to location, lack of services, lack of roads or transport or other factors, health facility-based services alone do not provide adequate access to treatment (in many countries, not just Ghana), and, not within the crucial window of 24 hours after onset of symptoms. So CCM brings the treatment to you.

It is affordable, treatment is cheap, and if you can’t afford even the recommended amount, it is given for free. Oral rehydration salts for diarrhoea costs a parent about 5c. Of which, 2c goes to the volunteer as ‘motivation’ – the only form of payment these hard working people receive. They are not officially identified as Ghana Health Service employees, and must keep other, sometimes multiple jobs to make ends meet.

The volunteers are given a large workload. Treating, screening and providing follow up care to the whole community. They must report to the closest health clinic once a month with the statistics of who and what they have treated, and re-stock their medication boxes. No transport is provided, these volunteers may have to walk kilometers, with no reward at the end. However how do you fill a report form when you cannot read or write? One health worker I met created a system to help him get reports from the volunteers. In a large jar put a grain of maize for every child 6-11 months treated for malaria. A grain of rice for every child 6-11 months treated for diarrhoea, and a grain of sorghum for every child 6-11 months treated for pneumonia. In a small jar do the same thing for children aged 12months – 5years. Genius.

It is innovations, cooperation and programs like these that makes this country so interesting. Yes, you get many volunteers who do not report, or health workers who demand written forms, but bit by bit Ghana is adapting its programs and building up its people to create something that will one day be a solid health system, built firmly on the strength of its amazing communities. This is dedicated to all the volunteers who give their time to the program, I am so proud of them, and continually hold them in such high esteem. I wish for them to be recognised and given employment entitlements, better status and the thanks that they deserve. 

Meet one of the volunteers - click here.

Corporal Punishment

Driving past schools here can sometimes see either all the kids out in the field with machetes cutting the grass (apparently it's bring your own machete), or a whole class being punished. Like this photo. We stopped when we saw this entire class was being punished. The headmistress was involved, and it actually took a lot of convincing to make the teacher stop the punishment. Apparently the class had all laughed at someone, so the entire class was being punished. Finally my colleague succeeded in stopping this punishment, but who knows what happened an hour or so later.

I haven't had much to do with the education system in Ghana, just heard what other people know who are working in it so I don't have a good background, just observations. Corporal punishment is the norm, and when teachers do turn up (mostly they don't), it's highly likely someone that day will get some form of punishment. I think this one is one of the worst. As my driver put it, it'd be better to make them do something useful, or so they learn from it - maybe picking up all the rubbish around the place.

It's hard to watch, and I'm so glad we could intervene. But it was a temporary fix. Apparently there was a survey on children in schools recently, and the children voted to keep corporal punishment in schools. But maybe that was due to fear of repercussions. I have friends who have volunteered as teachers, and the children ask to be punished, they are used to the discipline, or expect it.

Ghana is on target for reaching the Millennium Development Goal #2 of Universal Education, however this has simply meant building plenty of schools. There are no qualified teachers, and the quality of the education is poor. As I have not had much experience with the schools, I have only entered a few, I'll end it there. But Ghana has made me appreciate the education system at home so much, and makes me hope for many more improvements in Ghana.

The 'Forgotten Killers'

Have a guess at the world’s biggest infant killer? Something scary, something unpredictable, something out of our scope to help with???

Pneumonia.

Closely followed by Diarrhoea.

In Ghana the problem is the same. Diseases that don’t really scare you at the thought, or make you think of death. But they are killing children in Ghana and the rest of the world, yet have such simple solutions.

You can  prevent pneumonia by washing your hands before eating. It’s not expensive, out of reach or ‘innovative’. To cure pneumonia you take some antibiotics. In Ghana they can cost as little as AUD$1.00 or if you can’t afford that, it’s free.

Diarrhoea can similarly be prevented and easily treated, again, hygiene and sanitation is key. But these diseases reflect more than just the diagnosis, it shows the living conditions, poverty, and healthcare accessibility of those severely affected. When you think about #1 cause of death in Ghana (or Africa in general), the cliché is to blame HIV/AIDS, maybe conflict, or some obscure disease like Nodding Disease. These are all difficult things to tackle, with big social impacts, or costs involved. But HIV rates in Ghana are 1.8%. The percent of children with suspected pneumonia receiving antibiotics is just 24%. The percent of children with suspected pneumonia taken to an appropriate health care provider is 51%. It is clear where the biggest impact can be made in health.

Ghana has just introduced 2 new vaccines to help prevent both diarrhoea and pneumonia. There has been much media coverage, and here is a great video about it.

Other things that are being done are;

1.  Promoting exclusive breastfeeding – by giving nothing but breast milk for the first 6 months in life it prevents infection, contamination and malnutrition. A simple, but effective way to ensure good health for your under 6month old. The problem lies in the following years where food is introduced, and it is often inadequate or insufficient.

2. Sanitation and hygiene. Ensuring all households have access to safe drinking water.

3. Community-based treatment of childhood illnesses. A program where volunteers in the community bring diagnosis and treatment to hard to reach places.

4. Promoting handwashing with soap. Massive campaigns and strategies are in place to improve handwashing. A study I worked on recently found that just 6% of people use soap. And then it mostly was for washing clothes rather than hands.

Wash those hands!

And for the final say, here is a news story on the current situation.

On THe Road

One experience was quite traumatic during my weeks on the road. We were travelling between towns, and came across a man and his mates, who had come off his motorbike. It looked like the front tyre had blown out. And he hadn’t been wearing a helmet. The gravel road had caused much damage, and as much as I tried not to look, the man’s face had been severely injured and deformed. Being a UN vehicle, the policy is we do NOT take passengers, or stop for people. But my driver and I decided to stop, it’s a deserted road, you can’t just leave the scene, and we could help. Not to be mentioned to HQ. So we put the man in the tray of the ute (so lucky we had this vehicle and not the new Landcruisers) and started back to town – fortunately I knew the Polyclinic, I had worked there previously. His mates on motorbikes were going to escort us, but we had to keep stopping because the man was trying to jump off the ute. I was sad to see that the friends sped off, we were left with this man we didn’t know in a critical condition.

We slowly made our way back to town. The ambulance was not an option because there is rarely fuel for its use, and regardless, we were at the scene.  We were fortunate in that my driver had made one friend come in the tray with the victim, as he needed constant care and placation, I’m sure there were head injuries/shock involved. The friend must have been a ‘strong man’ and my driver also had to keep an eye on him in the mirror for fear of him jumping out. I tried not to look at the man, it was a pretty horrific sight. I don’t know how they did it, I won’t go into details, but inside the car we were so quiet and tense, despite the 40 degree temperature I was so cold.

We got back into town and as we drove into the clinic, all his mates arrived for support and help. It was such a good thing to see. I met the district health director and she assured his care, telling me that the doctor was in today. This was much relief, as you never know the treatment you are going to get in the health facilities here. We left him with half the town supporting him. They thanked us, and got the vehicle washed, it was covered in blood. My driver asked me about HIV, which I thought was so great; It’s not an easy thing to discuss here. We talked about the health facilities here, the community support and about meditation.

It was a surreal experience, one I have not had much experience with before. I thought of dad and Uncle Bob doing this with the rescue helicopter at home, seeing things like this several times per day, I was affected just by one incident. Despite being queasy with some gore, I was fine, and my driver commended me for not being scared of blood! I told my driver about our helicopter services, reliable ambulances, and healthcare. We have all that, and Ghana doesn’t, but I was so incredibly comforted and moved by the community spirit, support and kindness of this town. I could leave knowing that in some way, he will be ok.

Me and My Driver

I have spent the best of two weeks driving around the Northern Region of Ghana supervising a large scale survey. More about that later. The best part for me has been getting to know my driver. This is actually a rarity in Ghana, as most people are cautious about what information they give out to you. The colleague I’ve been working most closely with for the entire 8 months announced to me the other day that his wife had just given birth. I had travelled and worked with him constantly, daily for all that time and he’d never mentioned her or the impending pregnancy.

So my driver and I went on a mission to small communities in 3 districts. These were sometimes as small as 14 houses. He was the most cautious, safe driver I have had, so this was reassuring for the duration. He would stop and ask for directions (imagine a man asking for directions!) and his English was great, so we talked the whole time.

He told me some fantastic stories, of the highlights:

·         Recipes – he cooks most Ghanaian dishes (including cat and dog).

·         How he won a regional award for his animal farming and was so proud. Aiming for a national award now. It was so nice to see how proud he was, and also how he treats his animals.

·         He bought a ‘home used’ (ie second hand) bicycle and was so excited he rode home 40kms. He rode so fast it took the same time it does to drive, but when he got home he was so exhausted he didn’t know what was happening to him. So he took himself to hospital! He was sore in the joints and they treated him for malaria!! He said he’ll never ride like that again. People here tend to ride pretty slow and laid back.

·         We discussed many things and he said he wants me to be a Big Woman. This does not mean fat (he thinks fat women are too slow), but an important person. He kept saying I should be a lawyer… probably in relation to my arguments pro-women’s rights. He had some interesting views…

I won’t share all the conversations and details, so as to betray his trust in our friendship. But there were some gems…. and some hypotheticals;

·         F: “What would your parents say if you came home with a black baby?”

·         Dee: “Would it be mine?”

·         F: “Yes, for example if you and I had a baby”

·         Dee: “I guess they would be upset that I kept it from them for 9 months!”

·         F: “I think the best thing would be if you got in really late, in the dark and did not wake them. You go to bed, and in the morning when they come and wake you, they see the baby?”

·         Dee: “Oh! I don’t think I’d want to give them a heart attack!”

But we were talking about racism. It is an interesting topic. He was so happy when I said that it is ok to be black at home, and people do marry different races. I guess for someone who has never travelled out of your own country, and have only met 2 white people in your life, you don’t know these things.

He was such a gentleman. Buying me all types of local foods. Carrying my bags. Ensuring my room was ok before I went in, and getting me to the places I needed to go. It’s been such a wonderful experience, and my first work on my own too!

Best Driver Ever

Parts of the weeks was sort of like being on holidays. We stopped at this ant hill for a photo. Nothing work related at all!

Dee Silting

What a job! Removing the silt from a dam so the dam has better water-holding capacity, by hand!
This community group is participating in a work for food scheme, where the whole community works on this project and gets 'paid' in food rations. It is another group affected by floods and the UN is trying to improve their livelihoods.

There was much talk about the project, how it could be improved etc, it was fascinating to watch. It was a Saturday, and so many of the community were at a funeral, so I can only imagine what it is like when the full community is present.

Tough work in the hot sun, even for me just standing there taking photographs! 

The Case of the Mosque and The Missing People

Not to let work get in the way of a good adventure, the team stopped outside of Wa for a look at one of the ancient mosques of Ghana. It’s made from mud and sticks, and is reminiscent of the Mali ones, yet maybe on a smaller scale (I haven’t seen the ones in Mali). It was great. 

The mosque, looking into the women's entrance

Inside, it was very small, but it would fit many people at prayer time

We got to enter (me through the female access of course) and even go to the roof through a tiny opening. The local kids caught onto the sight of cameras and went nuts. Can’t keep them away from the lense.

Next door to the mosque

View of the local town from the roof

Exiting the roof through a small hole. and windy mud stairs backwards. quite the skill.

A 16th century mosque, I didn't actually learn all that much about it but just enjoyed being a tourist. I looked it up to maybe shed some light or interesting facts on the mosque, but the best I could find is that it is "a very solemn place". Ghana has to work on it's online tourist presence a little bit... or I should listen more. But at least I didn't go AWOL...

No shoes were harmed during filming

After maybe half an hour investigating the place, we set off in the convoy again. However our car was missing the two journalists that had come along for the day…. So the security vehicle called the convoy to a halt and we searched the town for the journos. I’m talking a tiny village with a handful of houses. I couldn’t get my head around the fact we’d lost two people in this small town. And they weren’t from here too, so I’m sure they’d be noticed. After an hour of waiting, we found that they had caught a bus back into town. Who knows why. There was mention that they probably had a more lucrative story waiting for them in town. That is how the media works here, you pay for the journalists. Crazy. So this was an interesting insight into the media world!

The team was not happy, outraged at having lost an hour of time... even though we'd just spent the morning sightseeing. But we soon set off for more work site inspections, (sans journalists).

Camera spotted! posing starts. The children love tourists.

Children and their toys.... and giant smiles

security escort courtesy of the local kids

Waiting for the journalists to appear... the town locals quite enjoyed the drama

Upper West Family Meeting

Continued…

The convoy arrived in Wechiau, in the Upper West Region, a small community affected by flooding. The project we were inspecting was a livelihood development project, to move the income dependence of the community from farming to other areas. This women’s group was going to be supported in 1) making shea butter, 2) making soap and 3) baking bread. The floods and water shortages were compromising this community, the major flooding occurred in 2007, and I don’t think the community really recovered.

We were welcomed warmly;

There was a strong emphasis on gender, and it was quite ironic that the NGO staff were all men, representing this women’s group. So we asked the ladies to talk to us. They were clearly excited about having hobs and responsibilities, and reported their husbands are supportive. The Upper West is the worst in the country for women’s rights and equality, so this was great to see.

A lady explaining the women's group to us

We inspected the building of their proposed workplace, the building is currently under construction. The women come every day but have nothing to do. The team promised to install toilets (as the town has none, and people must defecate in the open) and basic sanitation, and proposed some literacy classes which caused a stir. This moved many of the women and they were so happy, it was pretty motivating, you know, exciting to see problems being looked at and promises being made. I hope I get to see the project come to fruition, the health sector promised some nutrition education as well which I was so happy to hear, a captive audience like this could really benefit from well-placed interventions.

The new building under way

It’s hard not to be skeptical, I really hope these things are followed through, but I feel maybe some of the promises were a bit empty. Time will tell, and for the moment there’s a group of women who are being promised the world, and I hope they get it because they deserve it.

The NGO representative (male) introducing the women's group

UN country team with the women's group. Girl power!

The UN team and women's groups

Leaving the meeting and the building, back to work in the house...

Nine Car Convoy

In a village where it is rare to see a car a day, and when that car is likely to be a beaten up old taxi held together with duck-tape, it is known that a 9 car convoy of white UN landcruiser vehicles will cause a stir.

Causing a stir in the community. All in a day's work.

The UN Country Team was in the northern region for a visit, and I was able to join on behalf of Health. We were to visit key sites of the different organisations, to observe what each one is doing, and see if everyone can join together and work as ‘one big family’. Many a corny reference to the UN being a family was made... I couldn’t tell you who most of my family members were! But it was a great experience.

Opening the water flow. The lady in orange is in charge of the water flow, and charges each barrel 5 peswars (about 3 cents) to be filled. She only had 1 tap open of the 6. We asked that they are all used. We were prepping the site before the convoy arrived

Preparing the Health Facility before the 'Family' arrived. They were sticking the table together with sticky tape. The volunteers and mothers waited patiently for a few hours.

We visited Tampion in the Northern Region to look at our organisation’s work. We met the chief of the village which is an experience in itself. Talking through interpreters, most of the community came to listen in to what was going on. The media brought some awesome old school cameras and put them right in the chief’s face and other representatives. They were late but made a good deal of noise as they arrived when we were deep in discussions!

The chief and his men

The media getting right among it. Loved their camera!

The water supply had been improved in the area, and Guinea Worm eradicated because the drinking water was now safe, it was previously a large problem here. The initial intervention was supplying the school with clean water, however the community were now crowding the water tanks, as the water supply is not adequate enough for the whole community.

Collecting water for home use. Complete with child on your back. Done with such skill and ease it looks easy. I couldn't pick up that bucket I don't think, let alone lift it to my head.

The handwashing facilities that we donated to the school. The water gets pretty hot out in the sun all day, but it has improved hygiene significantly.

Clean drinking water for the kids now in place at the school. Cross contamination isn't heard of here, but it was great to watch so many kids come out and enjoy a drink.

Previously to our interventions, no houses in the community had latrines, open defecation was practiced, however now all houses had a toilet, and some communities in the district are declared ODF “open defecation free”. Inspecting the facilities at the schools brought this into perspective; urinals for both boys and girls, and a hole in the ground for other business. However it’s a vast improvement on nothing.

The Tuck Shop at school

There is a small health facility in Tampion, with two nurses and bad road access. The small building was inspected, while meeting the community volunteers that the health service relies upon to treat all children under 5 for malaria, diarrhoea and pneumonia. There is also a malnutrition clinic here, with three new cases as we arrived. I spoke with one woman who asked what we are going to do about ensuring families have enough food. Simply treating malnutrition with food at the clinic is not going to stop the problem of inadequate supplies. Fortunately I have heard of some interesting schemes and programs aimed at addressing this. I hope it reaches this community.

Inside the health clinic

The mothers of the malnourished (current and cured) children, and the community volunteers on the right with their donated boxes of medication/treatment.

A quick in and out visit, but we were sure to leave our mark behind as we kicked up the dust all the way back to Tamale. The team visited the Upper East Region, complete with police escorts in the high (well, it’s all relative) risk areas, and I met up again with them in the Upper West. 

To be continued….

Neighbourhood Watch

Defining a Household:

“People who slept here last night and ate from the same cooking pot”

Does this mean that the Jenkins’ who often have three cooking pots (1 “normal”, 1 vegetarian, and 1 gluten free) is not one household? Three households under the same roof?

Defining a household is important in the nutrition surveillance system I am helping implement in the three Northern Regions of Ghana. It always brings such controversy because the living situations are so diverse here. It is not uncommon for many households to be living under the same roof (house). Hence the addition of the statement ‘eating from the same pot’. This will generally distinguish the different households, as commonly, food for only the immediate ‘family’ can only be afforded.

The average household size in the Northern Region is 6, yet the number of people living in a house can vary greatly. In one community I went to, the chief’s house contained hundreds of people, however many “households”. So it is an interesting question, and reflection of the living situation in Northern Ghana. I have been fortunate enough to go to the communities and help train the health staff on how to take height, weight, MUAC (mid upper arm circumference) measurements for malnutrition screening, as well as mortality and household data. It gives you an insight into the living conditions and cultural traditions as well.

The Dagomba tribe (Tamale area) generally give away their first girl child to a sister or brother, to help in the house. Once they are in their 20’s or so, they can go back to their family, but it seems there is always a disconnect between them.

The Upper West has the greatest gender inequality. Women may have some of their own land, however must farm the man’s land first, therefore never quite meeting the needs of their own land. I don’t think they ever can receive land through the death of their husband either, they must go to be a second (or third) wife in the husband’s brother’s household, or must marry again (which is hard when you are older).

Also the ‘community entry’ routine is interesting. You must greet the chief which means entering his home without your shoes, making sure you are lower than them, say hello (in the local language to really ‘integrate’) and clap your hands slowly. Then you ask permission, discuss, thank, and ‘dash’ or ‘give kola’ which used to mean a present or offering of kola nuts, but now it means give some cedi (money). Exiting the community is equally important and a visit to the chief must be made.

So back to the definition. According to Ghana’s standards, the Jenkins family home (when Kat and I still lived there) had three separate households living under the same roof. It's all relative, and a great lesson to learn living abroad. Never generalise but learn from your situation.... enjoy.

MUAC measurements being taken

Weighing child - with mother 'tared'

Taking household data. Under the tree in the village.

Height measurements mostly make the children cry... This one was lucky!

Community exit. Thanking the chief. and photo op!

All crammed into a 'tro tro' - a local minibus. was the way to travel!