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.

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….

A Ghana Food Demonstration

It’s the African stereotype – malnourished children. And just like fulfilling the expat stereotype of living in luxury and partying with all the other expats in town every weekend, I am working right among the stereotype.

Childhood malnutrition in the Upper East Region is 27%, present in close to a third of all children under 5. The national average of Ghana is 13.9%, the differences between the northern regions of the countryclearly showing the disparity. Remembering our own backyard, I found an old study in the Northern Territory that indicated a 20% occurrence of malnutrition in Aboriginal children aged 0-2 years, well above the criteria for needing a nutrition intervention.

Studying malnutrition in Australia, I learnt about ‘kwashiorkor’ – malnutrition caused by a deficiency of protein. The lack of protein causes fluid shifts; odema, or puffy feet, and, as it gets worse, face and body. It is a global term, but here I have found it is a Ghanain word – from the Ga ethnic group. It means “the disease of the displaced child”, or the curse of the second child, because it occurs when a baby is weaned off (high protein) breast milk, to the local diet of maize and/or other low protein starchy staples, often due to the arrival of a second child. They quickly become malnourished, and swollen with painful fluid, because there is little protein-containing food being fed to them. As the name suggests, it was, and still is, considered a curse of the child, and this is often difficult to overcome. Often preventing recovery.

To address the low protein diets, districts have been holding food demonstrations. I attended Karaga district’s (northern region), where a group of Mother to Mother Support Group (MtMSG) participants and other community based volunteers had gathered to learn how to increase the protein content of their local recipes for the children.

Are you thinking stainless steel benchtops, ovens and stovetops for everyone, MasterChef style? We were in the health facility compound, cooking Ghana style. Over charcoal cookers, with no tables, there was much food being prepared.

The scene of the food demonstration in Karaga

Maize is the staple in the Northern Region, with some millet, sorghum and rice available, all fairly low in protein (11%). To start with, the mother’s learnt how to make koko (porridge) with added soya flour (35% protein). The ratio of 4:1 was used so it wouldn’t affect taste, and be too costly. Soya is available to some households, it is grown as a cash crop; it yields a lot of money at the markets. Which brought about a problem: These people can’t afford to keep the soya for themselves and their families. If you can get better money for soya, then you sell it and buy a larger portion of maize as it will stretch further and fill more people for longer. But it is low in protein. Soya flour was also added to banku (fermented maize/cassava), and the making of soya milk was demonstrated. If this is actually used, as some mothers described, by keeping small amounts for themselves after selling at the markets, it could improve their children’s health remarkably (and easily).

Making banku with added soya flour

Dawa-dawa is fermented locust beans. This is high in protein, and can be used as a stock flavouring as well (instead of the dreadful Maggi/Onga stuff they sell here). This was added to some soups and jollof rice.

Dawa dawa before it is ground

Moringa is a plant that is said to cure all! Sort of like Ghana’s version of wheatgrass, or goji berries. The claims of ‘more calcium than milk’ have been proven false (the calcium it contains is not available to the body), and no actual human studies have been done, yet needless to say, Ghana really needs greens, so adding moringa to the soups and stews is encouraged.

Groundnut soup with moringa added 

Alifu is another green vegetable, as well as brau that was added to traditional soups that generally has no vegetables at all. These are readily available at markets, which made me happy because it seemed like a solution that could be adapted by the villagers.

Alifu and brau cut up ready to be used - this man  was one of the only men to participate, and did well, the women loved to have a friendly dig at him. Particularly when he made sorghum banku - sorghum is pink

Tubani is steamed bean cakes. These are a healthier version of kosee  and served with a sesame seed paste that was delicious. Steaming them in plastic bags made me slightly uneasy. They made both of these with added soya flour to boost the protein.

Steaming the bean cakes

Tubani and sesame paste

Kose, with the 4 types of koko

The aim of the demonstration was for the attendees to take the training back to their groups and communities and in turn, teach these people, to ensure the new methods are taken into the home. I sincerely hope that some of these practices will continue, to help prevent the occurrence of malnutrition. There is never one cause for malnutrition, with many social and cultural factors involved that are difficult to address. It does always seem to come down to money however, and simple sounding things to us, such as giving your malnourished child an egg from your chickens rather than selling it, is not always possible. But getting the food right in the first place looks at preventing malnutrition, and hopefully bringing about small changes in the overall food supply for the benefit of everyone.

The plan for 2012 includes starting demonstration gardens, which is a fantastic integration, hopefully I will be involved in this too.