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Experiences in Saboba.... |
We felt this was time not to be wasted, wanting to do something constructive, both professionally and personally. As young doctors we knew our chances of working abroad outside the English speaking 1st world were limited, lacking the experience to work for the larger NGOs in tropical medicine or relief work. But both of us had harboured ambition to work in the developing world since medical school and knew this was an opportunity that may not come again. We therefore felt our niche would be away from acute medicine, perhaps in health education. At a party we were introduced personally to an aspiring anaesthetist from Italy, Diego Manzoni. In 2001, while on his elective (yes, as a student!) in Ghana he forged a partnership with an Accra-based colleague, Divine (currently an ENT resident), who both set up a NGO called Health-Aid based in the rural district of Saboba-Chereponi in northeast Ghana, on the border with Togo. One of the recent African political success stories, much of Ghana still suffers from widespread poverty and underdevelopment, and the Saboba-Chereponi district is one of the worst off in the country. Located in the midst of the African savannah, it is an area more than 2000km2 consisting of 408 villages, each containing 50-200 villagers. The villages are spread far and wide, with little or no infrastructure –mud-huts as homes, no access to piped clean water, no sanitation and a very poor road network. Transport is either by foot or bicycle. Farming is the mainstay of what employment there is. Though formal education is now available, school buildings are dilapidated, resources scarce, and children (especially girls) are lucky to be able to finish school due to the need to earn money for their families. Access to health care is hugely limited, there being one main medical center in the town of Saboba run by an American surgeon, but still lacking most of the resources regarded as essential in the developed world. The nearest proper hospital is over 2 hours drive away, with most people lacking access to cars anyway. Predictable health problems prevail – infectious disease, particularly malaria, malnutrition and dehydration, high infant and maternal mortality.
Once we arrived in Saboba, nothing could have prepared us for the culture shock. This was an area where indigenous and traditional ways of life have obviously prevailed over generations. But without wishing to romanticize this point, it has to be emphasized that this region is mired in poverty. Prior to our arrival, Health-Aid had completed the building of their own headquarters, and we were privileged enough to be the first occupiers. Amenities were less than basic, but for this area, nothing short of luxurious. Building one’s own outdoor latrine in the middle of the African savannah is surreal! Staff consisted of the two authors of this article, Dr. Manzoni, 4 medical students from Accra, and 5 local workers. Three teams were formed consisting of 1 doctor, 1 student, and 1 translator. Six days a week each team was sent to a new village either by bicycle, pick up, or river boat. On arrival, permission had to be gained from each village chief. The doctor would proceed to talk, via a translator, to the villagers about HIV, nutrition and sanitation. The talks were always lively affairs, as the villagers would gather keenly to hear from the foreign visitor. HIV would usually arouse the most animation, as many people wanted to air their concerns, thoughts and perceptions about the disease. Giving these talks and hearing the views of the locals one quickly realizes that education is the key to long term success in the battle against infectious disease. Some of the misconceptions of HIV are clearly a major obstacle in understanding and therefore preventing the spread of the disease; for example that the same condom can be reused over again, and some of the more educated members believed AIDS was nothing more than a political tool of the white man (“America’s Intention to Destroy Sex”). No amount of medical care or research can match the power of education in this war.
The talks would last around an hour, and then for two hours the doctor and medical student would set up a mini clinic for medical consultations – something some villagers would never have access to. Naturally our equipment was limited – a medical box of analgesics, some antibiotics and antifungals, disinfectant solutions, and chloroquine. We had no access to investigative procedures and follow-up of patients was impossible. As Health-Aid is an education-focused NGO, our role here was essentially to screen for sick patients and urge them to go to hospital if possible. This was particularly important in more severe acute conditions, paediatric, dermatological and gynaecological presentations, where the necessary expertise is not available. We were able to treat some simple infections and offer some analgesia where indicated. Management options being so limited, consultations were often frustrating experiences. However, they did offer doctor and student alike an unprecedented opportunity to practice communication skills (histories were done via a translator), focused history taking and examination (an average of 20 patients would be seen in 2 hours), and exposure to a variety of exotic signs and presentation uncommon in the UK. Later statistics were complied daily to record the ages, presentations and management plans for each patient seen so that eventually (this was the 8th action), with a view to eventually creating some sort of valid longitudinal health record for the area. Village outreach sessions would be finished by lunchtime. The afternoons were taken up by further teaching sessions of groups of 16-20 year olds from the local secondary schools. For them this was an extracurricular activity that they themselves requested from us, and being more educated than our village audiences, it meant these sessions could go into more detail about relevant health issues including family planning. These intimate lessons provided us with some of the most gratifying moments of our experience, seeing how keen some of the younger people were to learn and take responsibility for the future health of their community.
As members of a young NGO, volunteers are expected to take part in all aspects of the running of the program. Compiling statistics, taking stocks of medical supplies, food and water supplies for the guest house. In our case, after the departure of Dr. Manzoni in the second week, we were left in charge of the day to day running of the entire action. This included managing finances and resources, chairing the daily staff meetings and ensuring the smooth running of the daily outreaches. These responsibilities gave us the chance to develop our management skills – something that arguably may not have been possible working for a larger NGO or hospital. For us the whole experience provided everything we
hoped for plus a whole lot more. The program gave us an insight into
the value of health education, the views and ideas of people from a
vastly different way of life, and a means of hopefully continuing the
work through the Health-Aid Junior Program. The consultations have hopefully
enhanced our clinical skills, as well as showing us the limits of our
abilities. We would recommend this program unreservedly for any healthcare
professional, present or aspiring, who has an interest in health care
development in the third world and who wants to work for an organization
with so much potential for expansion. And a sense of adventure definitely
required! Michael Yousif, Bayju Thakar, November 2005 |
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The
recent article on what to do with one’s extended leave was indicative
of the situation of many junior doctors at this time. Having graduated
together from GKT in 2004, we both planned on a six month sabbatical
following our PRHO years and were both fortunate enough to have secured
SHO jobs in February 2006.
Health-Aid
is a health education focused NGO and being only 4 years old with limited
funds, it runs twice a year for 2 months, June-July and November-December.
During these ‘Actions’, Health-Aid staff and volunteers
travel to a proportion of these villages, giving talks on HIV, nutrition
and sanitation. Where possible, medical assistance is provided to those
who need it. This organization seemed to fit in to exactly what we as
young English doctors wanted. 
Unsurprisingly
perhaps, there seemed to be a greater sense of apathy and complacency
amongst the community when discussing issues of nutrition and sanitation.
This seemed to be partly explained by the difficulty the communities
faced in maintaining cleanliness, accessing clean water and affording
luxuries such as soap. But it is arguably more concerning than ignorance
of HIV when one considers that water and food borne disease are much
more prevalent than HIV in this area.
The
aim of Health-Aid is to eventually run throughout the year and become
fully self-sufficient. In support of this philosophy, the authors of
this article have set-up, together with the pupils from the local school,
the Health-Aid Junior Program. This involves specific education on health
issues to a select group of pupils who will then over the next year
visit the junior secondary schools of the district and pass on this
education to their younger colleagues. Specifically our role in this
program involves supplying the necessary funding and teaching matrials,
and acting as the necessary authority to the local headmasters, all
of which will be carried out via local Health-Aid staff and further
future visits to the area. All being well, this program will expand
beyond the schools into the villages, and Health-Aid education programs
will be run by Ghanaiains for Ghanaians.