The ICHA Blog
I am an SHS graduate preparing for my tertiary level education, which will begin in 2013. I attended Eguafo-Abrem Senior High School (2008-2012). I am 22 years, born into a family of five (5) with me being the first child. Being the first son my younger ones look up to me, so I always try to do what may be good to imitate. I always wanted to make a difference in my society. ICHA was made known to us by Mr. Brains and I was in the school science club as the president. When I realized the objectives/goals of ICHA, I knew this was my breakthrough to make a difference in society. Cardiovascular issues have not been the major talk of town and we are unaware that it is the centre of attraction of all the killer diseases. With ICHA I knew I could touch a life.Continue reading "Life is Better if You Know How to Live it Right" »
The morning sun was up and so was the internet connection we had been waiting for. We had Jason's phone call to the network provider on the previous day to thank for it! After some minor tweaking of the phone settings, the mPACT BP tool worked smoothly. Never before in my life had I though I would be so elated to see the message "sending data to ICHA"! Today our task was to visit the four clinics in the KEEA district and ensure that the health workers were able to use the tool well. We also planned to take this chance to update the tool to the smart program that could communicate with the server.
My first stop was the Elmina Urban Health clinic. Clement walked with me, pointing out the various features and facilities, while patiently answering the questions I had for him. What I noticed immediately was the sheer numbers of people waiting to see a prescriber. This was not surprising as the Elmina clinic is the largest in the KEEA district. Also, this scene is familiar in most Indian clinics. What was unusual was that only 2 or 3 health workers were at hand at any given time to see the 100+ patients. I met one of the health workers who had attended the orientation for the mPACT program the day before. He showed me proudly that he had his phone out and ready to enter BP data. I was happy to note the enthusiasm in his voice. I briefly interviewed the triage staff who mentioned that they measured the blood pressure, temperature and weight of all patients. It was a little disappointing to note that they were not calculating BMIs as they had been taught before. The lab staff members at the clinic were very friendly. They showed me their diagnostic equipment including two glucometers which were not working because their batteries had died. New batteries that were shipped to them from the United States had been lost in transit. When I inquired about how they measured the blood glucose of their patients, they calmly mentioned that they borrowed a working battery from a guy who worked elsewhere. They said they picked it up from him every morning, used it during the day and returned it in the evening on their way home.
Next, Abby, Jason, Clement and I took a taxi to the other clinics. It turned out that the only health worker at Kissi had been called to the regional office at Cape coast, so we directed the taxi driver to take us to the clinic in Komenda instead. Again, there was only one health worker staffing this clinic. The Komenda clinic was much smaller than the Elmina clinic and there were fewer patients waiting in comparison. We updated the phone and asked the health worker some quick follow up questions before we left. Last on our trip was Agona. The town and the clinic are located in a very rural setting, several kilometers off the trans-African highway.Most of the drive was through a narrow unevenly paved road. The entrance to the clinic was very beautiful. Even though the building itself was very plain, there was a garden with blooming flowers that instantly cheered up the surroundings. The Agona clinic was much bigger than the Komenda clinic, but still smaller than the Elmina one. There we met another health worker who was a part of the mPACT pilot group. We were really impressed with this particular health worker's commitment to prevent and treat cardiovascular disease in his community. He had already compiled a database of his regular patients who were being treated for hypertension and hoped to use the phone program as a tool to guide their treatment. This meeting was undoubtedly the high point of my volunteer experience in Ghana.
The technical team confirmed that the program was online and they were starting to see a constant trickle of data. Thats all we hoped for at this point. With our mission for the day accomplished, we rode the taxi back to the comfort of the Dawson's lodge.
-The Mobile Health Team
Sitting by the Volta River in Sogakope, watching the heat lightning and trying not to think too hard about the mosquitos. Grateful the sun has gone down, grateful for the breeze, grateful and more than a little awestruck that we get to do the work we do.
I arrived in Sogakope yesterday, in a tightly packed van – half people/half rice/half market miscellany (if you counted 150% full, that's because it was) – and, within hours, was taken in by the community's hospitality and disbelief that ICHA has been working in Ghana for 1.5 years and has not yet come to Sogakope. So today was spent trying to remedy this, to evaluate launch of a new pilot program, to build the necessary foundation and troubleshoot potential barriers, so we can kick off asap. Ghanaians like swift action. If you have a good idea, let's go. For today's purposes, that meant a lot of driving, not nearly enough water, and a lot of meetings – with secondary school head masters, the director of Sogakope District Hospital, the public health coordinator at Ghana Education Services, teachers, a director at Ghana Health Services, just to name a few – all enthusiastic and all repeating (after hearing what we're about): "Ah, you are welcome. It is good you are here."
It's interesting to see in practice the things you learn in theory. A keystone to a strong community program – in Ghana and probably any other community – is understanding who the community respects and establishing relationships with the local leaders. If they agree with your mission, they will introduce you to the folks you need to know, explain your purpose and onward you go. Each community has its own systems (Sogakope is so different than Elmina!), but the basic principles are the same.
So, it seems, are some of the basic principles of Ghanaian culture. Inasmuch as someone from Eastern Region might tell you that people from Volta are different ("transparent and very loyal," for example), the enthusiasm for knowledge and its incredibly swift absorption, the commitment to health and community betterment, the excitement about programs like ICHA's is the same here as it was in Elmina. So, people don't know about heart health – "many don't even know that the food they eat impacts their body" (this is a direct quote from a teacher I spoke with today).
But people here want to know and they embrace you (literally) for coming and bringing this information. (And you get tears in your eyes, because you're just a catalyst for information that everyone has a right to without having to ask for it.) And you know that the information you are working with your new partners to spread will have a tangible impact on people's lives – not just thousands but hundreds of thousands. So how could you not want to just keep coming back to Ghana until you are entirely sure that every community that wants it has the basic information about health that we take for granted? And how do you sleep at night knowing that people die because nobody told them? And how do you go back to practicing law when you see how simple it is to make friends and make change?
I should end this here. But I want to impart (and know I can't) the overwhelmingly engaging power of this culture. The respect I have for the people I have met here. The profound sense of dismay at Ghana's poverty and the simple unfairness of it all, that most people have very little, that daily life is really – deeply – hard, that people die too young in this place. And that, through our alliances, we really have the opportunity to make things better.
It’s been a little over a week now since we left a chilly, rainy San Francisco and arrived in the overwhelming humidity of Ghana, and it’s truly been an eye-opening experience. The people, the culture, the politics, the lifestyle.
We spent the first few days in Accra with members of the Google Africa team, and met a dozen or so university students – each very excited to be chosen by Google to be on-campus ambassadors. Some of the students were from University of Cape Coast, which is very close to Elmina and we hope to be in touch with them again during this trip, to discuss a bit about ICHA curriculum materials as well.
In just a week, I feel like we’ve met some amazing people, and while one of our objectives here is to teach about the importance of diet and exercise on cardiovascular health, we are learning a ton as well. People we have interacted with have all surprised me with their level of education, enthusiasm, curiosity for why we’re there, and memory (they remember you, and are really on top of the work we’re doing with them).
My own expectations and standards are changing as well – I definitely don’t snack as much as I do back home! Mostly because it’s extremely hot, and I’m constantly drinking water. The living quarters we are in are truly luxury – and this means little things like having a fresh coat of paint, a fan, a desk, running water. The level of “making do” is just so impressive – old televisions pile up along the streets. In a different context, I would see these as antiques to be recycled. But here, TVs are luxuries. They really utilize everything until exhausted – things like pens, plates, anything really. Thinking about ways in which to make our messages stand the test of time involve things as simple as lamination, as this goes a LONG way.
Yesterday Francois and I treated ourselves to an afternoon by what must be the most luxuriest place in Elmina – the Elmina Beach Resort. We paid 7GHC to access the pool, and there were definitely fewer foreigners there than Ghanaians (and note that none of them go into the ocean, but will pay to be at this pool!). One night at this hotel is minimum $180USD. In contrast, the place we stayed during our first night here was 20GHC, or about or $13USD. Interesting to me that no matter where you travel in the world, and despite my own preconceptions of the level of poverty here in Ghana, there still exists a distinct income gap.
Two more weeks left, and I’m looking forward to making my way more into the community to interact with more people, not just in the schools and clinic. Also really looking forward to soaking in more of the history here as well. Tonight is Ghana vs. UK soccer game – it will be a big day!
It was orientation day! I was prepared to introduce the health workers in the KEEA district of Ghana to the new Mobile Phone Assisted Cardiovascular Teaching (mPACT) BP tool. The mHealth team of ICHA had spent several months designing, creating and testing the program that would eventually allow the Ghanain health workers to enter patient blood pressure data in a mobile phone and receive smart prompts about treatment guidelines. We hoped that these guidelines would make treating hypertension a breeze! However, not everything had been a smooth sail so far. Since arriving in Ghana, we discovered that the phones we had tailored our program to were out of stock in all the stores we checked in. Luckily, we found a similar phone that was within our budget. Once the phone was loaded with a SIM card and activated, I anxiously downloaded the BP tool. The download and one test data entry was successful but the program stopped communicating with our server soon after. The phones still refused to connect to the internet reliably on the morning of the outreach. By this time, the technology team in the US had been up most of the night, reading forums and trying to figure out what was wrong. Finally, Jason called the network provider only to learn that the company was experiencing outages in the Elmina area that would be fixed in 24 hours! We didn't know whether to be happy or sad! Patchy internet meant that the phones would not be able to receive the smart prompt for treatment guidelines. Instead, each time the health workers submitted the data, they would see an error message! However, it also meant that once the internet was up and running, our program would work again!
The technology team had been resourceful and prepared for a scenario like this. They had a version of the program that did not rely on the internet for providing the smart prompt. Although we would still not receive any data from the phones using this version of the program, at least the health workers would see treatment guidelines instead of an error message when they submitted data using the phone. At this point, we still had a couple of hours till the outreach was set to begin so we tried to download this "dumb" version of the program in the 30 sec intervals that the internet worked.
The health workers started trickling in at 1 pm. Polite welcomes and smiles were exchanged. Then it was time. I worked my way through the materials we had planned to cover, telling the health workers the objective of our program, why they should use it and how they should use it. Thankfully, the health workers had no problem learning the program. Individual questions about data entry were easily managed by Jason and Abby while the rest of the class followed along with me. The health workers were really excited about the prompts for treatment guidelines. As we ran though several example scenarios of the data, there was almost a competition as each health worker tried to be the first to report what guidelines were displayed! As we prompted for questions, we were surprised by the large number of relevant questions and great suggestions we received. Finally, we wound up the orientation and sent the health workers home with their new BP tool. Once the network was up again, we would download the smart program and start receiving data from the phones, but that would be tomorrow. Today, we had launched ICHA's first mHealth program in Ghana. It was time to celebrate.
The Mobile Health Team
I wish I came to Ghana with a blank slate. I wish I could say that I’m truly unbiased and open-minded. Unfortunately, that’s not entirely true! The reality is that no matter what you think, you’ll probably end-up with ideas about Africa in your head you’ve gathered from books, TV and other medias. You’d have this friend of yours that spent a week on some safari tour and brought pictures of exotic looking animals. You’d have heard about the weather so hot and humid you couldn’t hide from it.
I’m not sure what I expected from my first time in Ghana, but whatever it was, what I found is better.
The first thing that blew my mind is the people. After a week meeting with students and teachers from several schools, I’m really impressed by their warmth and friendliness. You’re welcomed with sincere smiles. Laughter is a very important part of the culture and they will laugh with you and tease you all the same. They also seem really happy to see you again when you come back. It’s just a pleasure to meet people.
Another thing that got me thinking is how they do business. Organizing things with people is fun. They are very action oriented and will make it happen on the spot. I experienced this on multiple occasions. Wanna print a large number of flyers for an event? They’ll call their friend that has a printing machine and negotiate costs. You’ll have the copies ready the next day. Anytime you want to know something they are not sure about, they’ll get someone who can help right away or pick up the phone right there.
All in all, my first week went extremely fast and was a blast. I’m looking forward to meeting more people in the coming weeks!
Dear team –
A year and a half ago, I wrote my first open letter to ICHA. We were launching our initial program in Ghana (training roughly 40 health workers at the Elmina Urban Health Centre) and conducting community assessment and reconnaissance for our second (what was to became the secondary school classroom curriculum and clubs initiative). That letter was a congratulations to our volunteers (many of whom are still with us today!) whose passion had made ICHA happen, and confirmation that the work we are doing is important and – if we do it right – will have an impact beyond what we can even imagine.
It's only a year and a half later and in forty-eight hours we will be launching our fourth program – a mobile technology pilot that applies basic, readily-available technology to solve a complex challenge in a creative and efficient way.
Also during the weeks ahead we will be meeting with community leaders and conducting teacher and student focus groups to further develop our secondary school classroom curriculum, providing students essential information about health and nutrition and empowering these students to educate their families and communities.
We will be assessing the impact of our clinical program, evaluating opportunities to create capacity for cardiovascular disease prevention and working with nurses to ensure that the patients who come to the clinic – one in three of whom is hypertensive – have access to basic information and treatment to prevent disease.
We will be working with student-run ICHA heart health clubs to sponsor a community-wide event to conduct blood pressure screenings and promote cardiovascular health awareness.
We will be meeting with the WHO, Family Health International, Doctors for a Right to Health, and ministerial officers and directors in health and education to evaluate potential partnerships and strategies to expand the reach of these programs to communities throughout Ghana.
And that's just a taste.
We – you, oh amazing ICHA'ers – put these programs together in record time, in your spare time, committing evenings and weekends and lunch breaks to meetings and research, hunting down resources and consulting experts to ensure our programs are the best they can be – not to mention developing organizational systems and strategies to turn our ICHA into a full-blown sustainable non-profit.
Thanks to you, this means we can operate major programs on a minor (barely breathing) budget. And this means we get to do things no other organization can – like develop and implement creative, evidence-based cardiovascular health programs in poor communities when funders still refuse to acknowledge that these diseases are one of the most devastating global health challenges of our generation. You guys are amazing and this outreach is going to be huge.
I'm on the plane and getting excited.
It is always hard to put pen to paper, or finger to button, as it were, after a trip to a distant land. The obscurity of capturing living and vivid memories in succinct phrases worthy of their descriptors is, in my mind, one of most difficult tasks in writing. So continues my struggle during my recent sojourn to Ghana.
As I sit here in a Charlottesville coffee shop, furiously pecking away at my streams of consciousness, proper words to describe my experience elude me. I learned long ago that only through travel do we realize how truly provincial we all really are. The beauty of travel, particularly to a destination that challenges your own paradigm of the world, is that the memory stays with you far longer than any trinket, souvenir or written description ever will.
The trip started quietly enough. With the assistance of pharmacotherapy, my last memory was that of a bad airline movie and a stale meal. I awoke with a thump in a new continent. The first couple of days were spent getting to know my colleagues: a medicine resident from India who recently crossed the intern year finish line, a sharp-minded first-year medical student collecting data for a research project, and a seasoned and wise veteran from...well...Michigan, I suppose, though recent Locums stops include Alaska, Hawaii, and Vietnam. The four of us would be spending the next two weeks teaching local health care providers - mostly nurses - some of the basic tenets of managing chronic diseases. Main topics included hypertension, diabetes, obesity, smoking cessation, proper diet, and exercise. Each of us was to lead sessions on these specific topics, but oftentimes conversations became appropriately tangential.Continue reading "Memories of Ghana" »
Today was last day of data collection and classes at the Elmina Urban Health Center. There were many people to say bye to and thank for sharing their time, open minds and the space of their clinic with us for two weeks. The class ended with more students than it started with, as healthcare workers from nearby clinics and hospitals trickled in to join us.
I felt that the class also ended with a general positive feeling of what had been learned and achieved. We decided to go over the post-test after all had taken it in an effort to solidify knowledge and address any outstanding questions. We went around the room as each person explained the answer to a question. This spirit of group-teaching had been echoed throughout the course – in which people would each take on teaching what they knew about a topic to open the discussion and teaching – rather than creating a lecture instructor-student dynamic. Healthcare workers continually seemed to seek us out to ask questions about the materials. For me, as a medical student who has not had the opportunity to do much teaching yet, I found great pleasure in explaining what my new, limited knowledge of medicine could add. The course also served as a platform to start off with making health lifestyle changes amongst ourselves – talking about the healthcare worker’s own daily lives and partaking together in an exercise walk.Continue reading "Last day in the clinic" »
I began my role with ICHA in the Records Office of Elmina Urban Health Center this week. Countless green “Ghana National Health Insurance” folders and patient health record cards pass through this room. I have set up my laptop station and two friendly clinic staff members, Justice and Ernest, have generously been helping me find the patient charts over the last year so I can record information on hypertension. From this seat in the Health Center, I have gotten the privilege of a birds eye perspective – of what patients come in saying, of how their complaints are processed, of how they are diagnosed and treated, and of how their illness resolves (or evolves) over time. The flow of a clinic has emerged from this process of data collection.
What it shows is a population of all ages experiencing a burden of the infectious diseases that we all imagine of a tropical, developing country. However, I have been struck by the large number of high blood pressure readings I have seen in my own cursory glances at the data. It has not been uncommon to see a patient diagnosed with malaria and hypertension at the same time. This speaks to the “double burden” of communicable and non-communicable diseases that countries like Ghana experience. Hopefully, this data on hypertension will help shed like on the silent processes of chronic cardiovascular disease that lie below the surface of people’s daily lives. One healthworker anecdotally estimated 5 new cases of hypertension/day in a clinic that sees an average of 150 patients per day.Continue reading "Gathering Knowledge" »
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The International Cardiovascular Health Alliance (ICHA) is a 501(c)(3) non-profit organization dedicated to promoting cardiovascular health in the developing world. ICHA works closely with local clinics and community organizations to provide knowledge and tools to prevent cardiovascular disease.
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