Monday, July 30, 2007

not just the good part 2.

I've had a week to think about this blog post, and what stories I wanted tell to show some of the harder parts of my stay here, and some of the challenges that Ghana faces. In thinking about what I wanted to write, I also thought about what I have already written and I want to make a small amendment.

I gave the image that I thought that all NGOs are evil. I've volunteering for an NGO that I think is pretty awesome. There's a lot of good people doing a lot of good things. I'm even coming around on the NGOs that use development practices that I don't agree with (like going to a community, drilling a well, and then leaving without any kind of hygiene education or teaching the community how to use the well, or who to contact if it breaks down etc) because I can still identify the good that comes out of it (another NGO or the goverment will train WATSAN committees and pick up the slack, and the community has another source of safe drinking water). It's a HUGE conversation and thought process to try to figure out what is good development, and I still have no idea. The best lesson that I've ever learned from EWB is that "development is complex." I'm not going to pretend I know everything or anything. These are all just my opinions based on what I see. To add to that, I'm really excited to hear from anyone that wants to challenge me on these opinions and ask me questions. I'm even more excited to see that people I don't know are reading my blog and hopefully enjoying my stories.

Now, onto today's stories.

Health Care
Ghana has a kind of health care insurance system. I don't know too much about it, but from what I gather people can pay about 82 000 cedies (about $10) a year and have their basic health needs covered. This means that if you think you have Malaria it will pay for the doctor's consult and for the doctor to write you a perscription, but if need buy the drugs then you have to pay for those yourself (about $7). If I'm wrong, please correct me.

The problem with this health care system is that the hospitals are usually only in the district capitals, so if you live in one of the villages then you have to travel to get the health card, which give an added expense. Also, it's a gamble. If you don't get sick that year, then you wasted a lot of good money, and getting that much money together at one time can be hard, especially if you come from a large family.

What happens instead? Instead of going to doctors, people go to see their local herbalist, medicine man, or juju man. This isn't always the worst thing; pharmaceutical companies have made billions (and more) stealing the secrets from these local medicine men, packaging them and placing them on supermarket shelves. In a lot of cases, what we buy are what these people are giving their patients raw. Sometimes it works.

Sometimes it doesn't. A few weeks ago a man and his five year old boy came to the local goverment to seek help. He was talking in Dagbani to start so I wasn't really paying attention until my eyes looked at the boy. He was serious and his right arm hung stiff and lifeless beside his body, his fingers stuck at a weird angle and the skin on his arm looked blackened. My coworker told me after that the kid had fallen and broken his arm on the football field, but instead of going to a doctor for x-rays and to get it set properly, they went to the local juju man instead. They were applying a mixture of herbs and chemicals to his arm and instead of fixing it, it instead had a weird reaction with the flesh and the bones were allowed to start heeling in the wrong position. Now he was asking for help to see a bone specialist in Kumasi or the boy would not be able to use his arm properly again.

This is just one story, but it's not all. I see so many people that are crippled because they didn't get the proper care, or that have injuries that could have been properly fixed. People that have problems that are fixed with a small surgery early in Canada, but here they are allowed to grow and worsen. I suspect it's the same with most developing countries, that a lot of things are overlooked, but the thing that I am frustrated with the most is someone willingly choosing NOT to go to a doctor. NOT to give their children the best that there is... but then I can also understand that sometimes the hospitals are too far and the cost of travel and time you are taking to go is too much.

I just keep thinking to the small boy. How his life will be changed because one day he decided to play football and fell badly. That he won't be able to do so much because of a bad decision from his parents and a juju man that didn't know how to set a broken bone.

Behaviour Change
Washing your hands is something that is ingrained into our culture, and yet, people in the western world still don't do it. Why? Now, what if washing your hands after you go to the toilet and before you eat could save your life? In a world where diarrhea kills and parasites and worms are passed from person to person like colds are in Canada, you'd think that washing your hands would be common sense.

Yet, somehow it's not. Somehow, despite all the education and workshops, people don't wash their hands. People are still getting sick and diseases are still being spread. The people here are not stupid -- they're incredibly hard working and smart and they're good people. There's still people in North America that don't wash their hands when the flowing water is right there! How are all the people in Ghana supposed to do it when water's not readily available and usually quite far away? Why should they be using so much water cleaning when during the dry season, sometimes there's barely enough to drink?

Guinea worm is one of the most awful things I've seen so far, and I live in an area where Guinea worm is at its worst. The flea that hosts the worm larvae is only just visible to the naked eye lives in the water. Once the flea is swallowed the worm travels to the intestines and mates. The female worm, now impregnated with thousands of larvae herself, travels through the body for anywhere between 9 and 18 months feeding on the host's tissues and bones. Now here's the really painful part: it has come out of the body somehow to recontaminate the water source and ensure the survival of the species, so it comes to the surface of the skin (usually in the legs or feet) and creates a large boil, which it will burst through when it feels water on the outer part of the skin. It will usually come out quite soon after the boil appears because the most soothing thing the host can do for the painful boil is to immerse it in water. The worm at this point is usually about a meter long (3 feet) and looks like a piece of angel hair pasta. Each time the female feels water, it will continue to release thousands of the larvae into the water source.

If you think what I'm describing is bad, the words on the page are nothing as compared to the pain and agony felt by the host when the worm is coming out, and it's not an easy process. It usually take ten to fourteen days for the worm to come out completely, and multiple infections are common. It's pulled out a little bit at a time each day and you have to be careful not to break it, theres' the risk of infection, or if broken right at the start, it can go back into the body and reemerge a week later.

It's a horrible parasite. It can take people out of work and school because of the severe pain. If you're a farmer and it comes at harvest time, your crop could be lost.

Want to know what can stop you from getting it? Filtering your water. If you get your water from a dam, stream, or other uncovered source, chances are that it's infected. There are a tonne of NGOs that are giving away filters to anyone that says they need one, and if you're not around those NGOs you can make your own. If you're out in the bush and are thirsty and come across a water hole without your official filter? You can drink the water through a handkerchief or your own shirt. If you have a boil or a worm coming out the actions you take should be simple: don't go in the water and continue to recontaminate the water source.

Yet, people continue to get infected. People don't filter their water. Despite hiring guards to keep people from going into the dams, people still find a way. How, with all the education sessions and posters and radio spots, do people still get this parasite? Is it that don't see the connection between their water and the worm? If it's growing inside you for over a year it's hard to make the connection, especially if some people get it and some people don't. You need to swallow both a male and female worm, so if the combination isn't right than you'll be okay...

The topic of behaviour change is one that I've seen before. How do you get people to drink fair trade coffee? How do you get people to stop smoking, especially when they know that it's dangerous? Why do people still drink and drive? Why are people not filtering their water?

I think that changing people's behaviour is one of the hardest and most complex things that anyone will try to do, but I also think that it's of paramount importance for development.

And I'm at a loss on how to do it.

In conclusion
This has been hard for me to write, but even harder for me to see. I hope that it gave you a small insight into some of the challenges that Ghana faces. It's really a wonderful country with fantastic people, and I'm having the time of my life here, but I didn't want to just portray the shiny happy moments. It is a struggle being here and seeing these things. I hope that I gave you a window into some of the harder parts of life here without it being too much like the commercials you see with the flies on the children's faces. I that you can see some of the real struggles here and some of the real people struggling.


Katie said...

A lot of what you wrote has a common theme: "Why do people keep smoking when they know it's bad for them?" and "Why do people not filter their water, when they know it will probably make them sick?" I think it's interesting to assess the different reasons that govern our behaviour. One of the factors I think is relevant here is ... there's a chance that you might not get lung cancer (think about the supposedly healthy eighty year old that has been smoking for 80 years). There's a chance that you might not get the parasites (Because some people must get lucky, right? Or else, everyone would have them). And so, the behaviour perpetuates. People like to think that it can't happen to them.

I think that the reluctance of humans to change their ways is deeply rooted in a lot of sociology that I don't understand ... but it does offer you some perspective as you work in Ghana. You can see the challenges faced by development workers on the whole - trying to get people to change their ways. You can ask the larger questions about whether or not that's even allowed - does someone have the right to tell others how to live, even if it could save their life? And most of all, you can see the similarities between cultures ... because people exhibit this stubborness the world over, in so many different settings and situations of varying severity.

Good luck on making some sense of it. Your two recent posts convey a very brave, thoughtful perspective. I am proud of you.

Adam F-K said...

First of all, I'm kinda pissed about the spam advertising from knicksgrl0917 above. It is spam. I looked it up. Don't click on it. JERKS! This blog has a lot of goodness to it and doesn't need spam cluttering it up or discrediting it.

I like the example about healthy living in Canada (not smoking, because it is chemically addictive). How many people know that we should eat a balanced diet, exercise multiple times a week, get enough sleep... How many of us do this? How hard is it to filter your water? Well how hard is to reach from one product to another healthier product on the shelf?

I just wanted to say that this post was very informative for me. Your insights and experiences will be great with the high school outreach water for the world program!

Jenny said...

I'm glad you post your not-just-good stories. I think it'd be heartwarming to think all of Africa is just as you talked about before, with the relatively-well-off families and colorful markets and wonderful traditions. But the reality just isn't like that, and you're living it, and we definitely take a lot from what you describe to us. I'm definitely proud to know you as someone who does fantastic things for the world! :)

That said, I MISS YOU LOTZ OMG. :)

kristin said...


You leave a good message wherever you go, keep trying to get through to others as well... it's commendable. On that note, your mom gave my mom some fair trade coffee for her birthday this past weekend! Were your ears burning?

Love ya!
Kris said...

I am so sad when you write so poorly about my beloved country. Knowing what your country can do ,I sense a tone of hypocrisy in most of the things you write. What do you mean people will save £10 if they fail to register for NHIS and did not fall sick in a year? From where ever you have come ,tell me how national insurance operates! Don't people pay far more than this into one account as a a form of insurance for the whole population in times of need? I am saddened that you could not even research this simple fact that majority of the drugs, including the major ones like malarial, are free under the scheme. Look, it is really bad if you put out falsitude out there about a country struggling to get to its feet when you, the rich and elite of this world who even got rich on our backs, stand aside and look!!?
Even go back to your countries and tackle your problems and stop discouraging good people who may want to go through 'the trails with us' from doing so. Pornography pours out from your countries to pollute our less educated folks and we cannot stop you! All manner of evil are in your society yet you do not raise a finger. Who says HIV is not a problem in your soceiety? But know one thing! The black man is capable of rising to the occasion. If there is one thing that I take delight in , it is the fact that my people ,at the climax of their determination, can archieve anything,. Trust me on this..I know. Who thought they could defiantly free themselves from British colonial rule? So note this. I see them still struggling with education and so could not figure out the problems. You people keep dividing them! Despite all these hardships, walk the streets and villages of Ghana and they love you, respect you, want to help you with all that they've got... What a contrast wallking the streets of the white man? But as i am saying , I know them. When the time comes and they realise who you are, they wii free themselves. They will become one and build a massive soceiety unconceivable to you. If you want a sign, find in history why most of the greatest leaders of all times were blacks... and in most instances they have to lead from the bearest minimum. God bless my country Ghana!!!!!!!!!!!!!Amen!

Anonymous said...

Hi Laura, I realize that your blog is about a stay in Ghana three whole years ago, but I am SO VERY interested in getting in touch with you to talk more about your experiences. I've recently developed an overwhelming passion for Ghana and can't stop thinking about it. I'm learning what I can (I'm teaching myself Twi:)... wo ho te sen?. :) I dream of visiting someday. If you get this message, PLEASE email me at
Thanks so much. I *really* hope to hear from you!

Anonymous said...

Hi - I am certainly delighted to find this. great job!

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Obibini Bruni said...

I don’t know how it was in 2007, but I had my NHIS card in 2016.
It covered most medical expenses in the public sphere, however not in private. Further, being obroni, I often was asked to pay more, under the assumption I had money – the people did not consider that I might have gone with private insurance if I had the money they thought I had! :P