Heart to Heart
The ICHA Blog
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Fortune and Cookies |
“You will step on the soil of many countries.” These are the things I keep in my wallet – a collection of ambiguous messages printed neatly on a 6 x 1 cm piece of paper (yes, I measured…). In 99.8% of the cases, these messages never resonate much farther than an after-thought; cleared and disposed of with the dirty dishes. But for some reason, I knew this one was a winner; and it is the opportunity (and through lots of hard work) that I have been afforded through ICHA to do just this.
This is outreach #2. The expectations unbeknownst to Lyza and me, but we can imagine. Since the inaugural outreach, the team has been conceptualizing, arguing, and printing out a series of educational material for cardiovascular disease and health. The message is clear; audience interpretation and reception…not so sure. However, this is the fun part for me – to develop a concept and message, and then observe and listen. By working with the community of Elmina, I hope over time they can better utilize our message to raise awareness and prevention of cardiovascular disease.
Since I’ve never blogged before (hi world), I’m going to take up this space to thank the team (they know who they are) and my family/friends for their support. I’ve got a long list of things to accomplish – some personal, some for ICHA, and one about cookies (but more about that later…).
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Hope for the Future |
How to describe such an immense experience? I feel as though I have been through a lifetime and back, however still have not processed the experience fully. We achieved so much, extending beyond our expectations and yet there remains an endless amount of work left to do. Each step we took opened doors to a whole new set of opportunity and need.
The Doctor and RN shortage in Ghana is astronomical secondary to lack of relocation incentive packages and lack of local resources. Ghana only has three medical schools, one of which has yet to graduate its first class. As of now, Ghana only graduates an average, of about one-hundred medical students a year! Most of these graduates flock towards the big cities, leaving rural areas barren. At the Elmina Health Center, nurses and medical assistants may see up to one-hundred patients in one morning, leaving patient to clinician ratios unmanageable. It is under these conditions that we set out to make our impact on lowering CVD.
At first, staff was overwhelmed by our presence. It was too much for them to lengthen their rushed patient interview to ask additional questions and check more clinical values. We were frustrated at first, but then extremely encouraged by high lecture turnouts and gradual clinical change. Clinicians traveled from all over the greater KEEA area, during office hours, to attend our lectures. They did this with enthusiasm for two and a half weeks. Educational levels varied, so each student took away what they were capable. All took away an understanding of preventative CVD and Stroke measures, diet and exercise. Some were able to absorb all we presented and apply them to their own lifestyles and clinical practices. All yearned for more and begged our speedy return. As a parting note of encouragement, we traveled to a nearby clinic run by some of our students, where our teachings were in full application. I look forward to returning to Ghana and expanding to this second clinic. It is through return repetition and slow expansion that we will make an impact.
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Lessons from Elmina |
We went to Elmina to teach health workers about cardiovascular disease, and we left with new lessons for ourselves and our organization. One of the biggest lessons we took away from interacting with the health workers at Elmina Health Center was the enthusiasm and delight of learning something new or seeing things in a new light. The health workers at Elmina had such earnest interest in learning that it made the topics of cardiovascular disease even more exciting because of their energy. They brought insightful questions that made us realize that what seemed so concrete now has to be flexible enough to adjust to cultural interpretation. We realized that we could not simply say “You should not have salted fish and carbohydrates like cassava”. Since these are the main source of frugal nutrients, we had to stress moderation instead. One has to look at why their diet is composed of foods high in salt. If they had dependable electricity and refrigeration, they would not have to salt their fish so as to help preserve it. By this notion, we come to see how something as fundamental as electricity actually has a huge impact on the source of hypertension for many in Ghana.
Another lesson that we took away was the importance of taking care of others to your best capacity. Ghana has nationalized health care. Patients can choose to pay $15 a year to have health insurance. The insurance will cover for clinical consultations and medicines. Because infectious diseases are very prevalent in Ghana, one realizes that by providing medical care to others, they also are protecting themself from acquiring some of those infectious diseases. Therefore, one comes to acknowledge the value of providing healthcare to those who normally could not afford it. However, with more health insurance comes more patients. There has to be a system to encourage more health providers to work in villages and provide care in remote areas. The quality of patient care can be improved by decreasing the provider to patient ratio. If we increase the number of patients, we must also have ways of increasing the number of clinicians. These are lessons that seem very relevant in our out society as the health care debate continues.
Continue reading "Lessons from Elmina" » |
Exercise, Ghana Style |
Hold that jump rope
As an avid runner, before leaving San Francisco for Ghana I was trying to accommodate my running ‘habit’, and bought some helpful aids to maintain my cardiovascular fitness. I decided the main way for me to keep aerobic fitness was to bring a jump rope. Mostly I was really sure if opportunity and the specifics of the area would be conducive to running. However, on Tuesday morning I finally had my virgin run on the TransAfrica Highway. An early a.m. run before it got too warm and while there was still some early cloud cover allowed me to finish about 8 miles. I have had a couple of other shorter runs, including a set of 4 x 800s (roughly) and another 6-7 mile run on Friday. The diesel from the trucks and cars is pretty nasty to be breathing along the road, so that makes it a little unpleasant. And the other day running I saw goatkill… there are lots of goats wandering everywhere, and I suppose such an incident is inevitable with all the speeding cars.
World Heart Day in Cape Coast
We got up at 5 a.m. Saturday morning in time to join our partners in reducing cardiovascular risk from the Elmina Health Clinic to attend World Heart Day activities (mainly a walk) in the nearby city of Cape Coast. Hundreds of mostly young people sang the walkers through a loop of Cape Coast; including the locations where President Obama spoke when he visited with his family this past summer. The day was finished with some time at the market, a tour of Elmina Castle to learn more details about a central player in the gruesome Trans-Atlantic slave trade. The day finished on a more light note, sharing time with new friends (ICHA colleagues) and going for a swim at a great beach west of Elmina...
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Reflections |
As I reflect about the past couple of weeks and ICHA’s progress during our first outreach, I am inspired, grateful, almost giddy about our success. We have been very fortunate. Health workers, community members, chiefs, local media—everyone has been welcoming and receptive. People in this community seem genuinely engaged and interested, eager to be educated and to educate others about the suffering caused by preventable non-communicable diseases. Everyone has a story—an obese aunt, a hypertensive grandmother, a brother whose leg was amputated due to a diabetic foot ulcer. ICHA’s core values, empowerment through education, the power of prevention, community involvement, have all been at the forefront during this outreach.
But, as I step back from the warmth and affirmation of this amazing community, I realize that we have our work cut out for us. Chronic diseases are not simple illnesses that can be cured with a pill or a pamphlet. Lifestyle interventions involve changing the way people think about their bodies, their lives, the role of health care and the ability to really effect change in their own lives. In the developed world, most people know that tobacco abuse is harmful, that obesity will shorten their lives, that diet and exercise are vital. And yet, the rates of obesity are skyrocketing, and cardiovascular disease is still the number one cause of death in the world.
This is the challenge and promise of ICHA. Our modus operandi is education. We see the power of showing an individual how simple changes in her diet will improve her quality of life tremendously, the effectiveness of teaching a health worker to give inexpensive anti-hypertensive medications to prevent strokes and heart attacks from ever happening, the importance of teaching in the schools, in the churches, and in the community. But while education is vital, we also have to find a way to translate education into action, to incorporate into communities and better understand how people can live more healthy lives.
So, as ICHA takes a moment to breathe and to bask in the affirmation of a very successful outreach in Ghana, we must also take a moment to respect the ambitious nature of what we’re trying to do, and to reflect on the tremendous challenges that lie ahead.
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The Church Council |
The church and Christianity is paramount in Elmina and Ghana. In fact, even the names of all the shops are after a religious phrase like, “Blessed Be Beauty Supply”, “Jesus Loves Cameras”, “King of Kings Chop Shop”, and my favorite, “It Is Not My Strength Auto Repair”. Everyone we have spent time with goes to church at least once a week and services are held almost every evening. One of the most common questions we get is, “Do you go to church?” In the public schools, the most popular and active clubs are the religious ones. Obviously church is an extremely important part of the lives of the people here, so it makes sense for us to include the church communities in our projects.
Tim and I (community outreach team) met with a local pastor who was interested in what ICHA is doing. He invited us to the Church Council meeting, which happens to meet on the first Monday of every month. The Council is made up of about 50 churches in Elmina. The meeting was held at the Methodist Church, one of the biggest, whose adult congregation is about 600.
We had prepared a brief introduction and explanation of ICHA and our outreach in Elmina, expressing our desire to work with the community. We gave a survey of potential activities they may be interested in for their church communities the next time ICHA is here, including a walking group, cooking classes, a fitness competition, and lecture event. We also left them with a basic CVD fact sheet for take-home. The reception was great. There were about 30 pastors or church leaders present, both men and women. They seemed genuinely pleased to have us there. From the feedback we got, ICHA is the first NGO that they have worked with. I feel excited and privileged to have taken part in their fellowship. It will be exciting to develop a program that involves such a large and active population of Elmina. I look forward to partnering with them in the future.
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“Your heart is you!” |
The end of last week proved to be a very busy one for us here in Elmina. While the clinical team continued their hard work at the Elmina Urban Health Center, Lyza and I have been busy visiting schools, meeting with teachers and headmasters, and working closely with an officer from the District Education Office to develop a program for the schools. Most recently, we met with the SHEP (School Health Education Program) Coordinator, a liason between the Ministry of Education and the Ministry of Health. We discussed a school program to include a CVD workshop for teachers, a Heart Health Week, and a student-run Heart Health Club in the secondary schools of the KEEA municipal. She was enthusiastic, supportive, and excited about the development of these projects. We definitely have our work cut out for us!
We also had the privilege of meeting with Mr. Brian Daniels, a teacher, volunteer, and youth health educator. He comes to us rich with incredible experience educating the youth from all over Ghana about the importance of health, be it HIV/AIDS, polio, sanitation and hygiene, nutrition, or reproductive health. He too expressed his enthusiasm for ICHA and has inspired us to work hard in the coming months. At the end of our meeting, Mr. Daniels reached out his hand and expressed our need to come together for humanity. "Your heart is you!" he said, "If your heart fails, you fail."
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Snippets of Early Impressions |
EUHC is not a local dish
The Elmina Urban Health Clinic is bigger than I imagined, but luckily so. Patients fill the open air waiting room and line up very early in the morning. Clinicians begin seeing patients shortly after 9 a.m. And although physically bigger, the facility is very basic in resources and equipment. There is a dispensary onsite that has basic medicines in limited quantities. Furthermore, malaria is prevalent in Elmina and surrounding communities. Consequently malaria consumes a lot of the time and resources of the health care staff. As a result, non-communicable diseases can find it hard to be a priority on a patient chart. But that is why the ICHA can have such a big impact here. To be here and to identify the practical constraints and opportunities has added the extra challenge of on-the-spot troubleshooting of draft frameworks to conform to the cultural and practical medical norms at the clinic. The opportunities more than offset the constraints and everyone is excited as our plans start to be implemented with the help of the local people. The staff has been incredibly welcoming and accommodating during our first week here. This is all the more remarkable given the huge patient load with which they are dealing.
A national health insurance program
Ghana started a national health insurance program a few years ago. It’s interesting to learn about the program and discuss its impact on people, particularly the poor, which are served at the clinic in Elmina. It’s also a timely conversation for those of us living in the US, as the topic is largely dominating the political landscape at home. From what I have gathered, Ghanaians between 18 and 60 can buy the national health insurance for 15 cedis (around 11 USD) per year.
Choose your competition
Although opponents in the US to a single government-run choice in national health care insurance, I was reminded that the tolerance for competition is also cultural… For example, mobile phones in Ghana typically carry two or three SIM cards, allowing the user to optimize service opportunities, but also, choose the service provider with the cheapest rates in an area of service when service areas overlap. To me, this sounds like a more competitive system than the one we use in the US and Canada in which a consumer is left with whatever service the provider offers after signing a service ‘contract’ (the cost of which to break said contract can cost easily 10-15 times what national health insurance costs for one year in Ghana). So it would seem different countries and cultures have different tolerance levels for market ‘competition’ depending on the product in question.
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Meeting the chief of Elmina |
As is customary in Ghana, before we started working in the clinic and the community of Elmina we were introduced to the local chief and queen mother, and the traditional council. Through the Medical Director of the clinic, who acted as a translator, we explained to these leaders the purpose of our visit and our plan for the next few weeks. The chief, queen mother and councilmen welcomed us graciously and thanked us for the good work we set out to do.
It was a fascinating experience visiting with these traditional community leaders. While there was definitely a strong feeling of deep-rooted custom, there was also no escaping modernity. During the ceremonial pouring of libations, when a couple of the councilmen prayed to the ancestors for us to have a successful visit, we heard a beeping jingle and noticed one of the other councilmen pull a cell phone out of his robes and answer a call! It was an amusing reminder of the strange circumstances in which we found ourselves, and we all had a little chuckle (including the councilmen!)
Meeting the chief was a very important step for ICHA. We now have his all-important blessing, and have been officially sanctioned to work in the community on this and all our subsequent outreach trips to Elmina.
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An Open Letter to ICHA |
My dearest ICHA’ers,
Good morning, everyone!
It is roughly 7:30 here, still just after midnight back in CA, and ICHA’s first outreach is in Ghana!
As we speak, Sujatha is preparing for a formal meeting with the district head of medicine and for ICHA’s second day of health worker trainings in the clinic. Our program development team is setting out their contingency plan for the day in the event that their meeting with the chief of Elmina gets postponed till tomorrow. A group of our clinicians is out on an early morning health outreach in a small village outside of Elmina, taking blood pressure and encouraging people with hypertension to come into the clinic to get treated by the workers we are training. I’m sitting outside, watching women walk past in bright dresses and with assorted everythings on their heads, and preparing to travel to Accra for meetings with Dr. Boateng, the President of the Ghanaian branch of the World Heart Federation and CEO of the Korle Bu teaching hospital and, later, with a colleague from USAID. Busy morning.
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So, my friends, I’m not quite sure where to begin. I came on this outreach, after nearly 16 months of preparation, half believing that we would arrive and find that we’d misjudged. That we’d be overwhelmed with a level of poverty we simply couldn’t impact, problems we weren’t prepared to solve, that cardiovascular health was the wrong answer, a misallocation of resources and ICHA’s spirit of well meaning.
Not so. Really, really not so.
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About ICHA
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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