Heart to Heart
The ICHA Blog
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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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Four days in |
We’ve been in Ghana for four days now. Needless to say, it feels like we’ve been here for much longer. It’s been an odd sort-of-homecoming for me. I’ve had emotional reunions with dear friends I left behind, and have spent the past couple of days reacquainting myself with the sights, smells, and sounds of this town. The sight of the fishing boats moored in Elmina, the pungent burning smell in the air, the thick warm humidity, the sounds of singing and clapping in the distance…are all strangely comforting in their familiarity. It makes me remember how, when I came back from Ghana last time, I found myself homesick for this place that was only temporarily my home.
As for the clinic, it is the same bundle of contradictions that I remember from three years ago. The patients are very sick, sweating in the overcrowded waiting area, glassy-eyed and listless, babies shrieking in the background. Everything feels haphazard—patient records lying in piles on the table, medications scattered in boxes on the floor, patients waiting in a throng at the front of the clinic—but there are also glimpses of organization. On the first day we learned that we would not be training 10 health workers, as we had originally been told, but forty. The Ghana Health Service had been so excited about our program that they had arranged for staff from surrounding clinics to be bused in daily. The health workers were enthusiastic, engaged, excited about learning this material that would help them better care for their patients.
Continue reading "Four days in" » |
Akwaaba |
Welcome! It’s hard to believe we’re finally here in Ghana! It’s been a really great visit so far – and really busy! When we arrived in Accra, we jumped straight into a van that took us to Elmina, where we’re working. Elmina is a town of about 25,000 people, situated on the coast about 2 hours drive west of Accra. The economy of the town is centered around fishing and, as you can see from the photo, there is a busy port where the long wooden fishing boats are docked when they’re not out at sea.
Our first full day here was a public holiday, in celebration of the 100th anniversary of Kwame Nkurmah’s birth. We spent the day exploring the town and meeting with community members, while the clinical team set up shop at the Elmina Urban Health Center, where they will be educating the community health workers about cardiovascular disease prevention.
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My bags are packed, I’m ready to go… |
It’s the night before departure and the feelings are familiar. I’m anxious to get back to the sights, sounds and smells of Africa, and to get to work. Part of me is kind of wishing we had another week to prepare! But I know, having been in this moment before, that this is only nerves – we’re as prepared as we can be, and we really are poised for success.
Besides, all the preparation in the world couldn’t guarantee that we’d be able to anticipate every challenge we might come across. Establishing a participatory health awareness program on topic around which there is very little existing awareness will be difficult, to say the least, especially in a resource-poor environment such as the one we are stepping into in Elmina. But the work we have done over the past year has brought us to this point – where we have the tools, knowledge and connections we need in order to engage the community in the planning and implementation of such a program.
As my laundry rolls around in the dryer and I’m checking the last few things off my packing list, it’s finally setting in – we’re going to Ghana tomorrow. We are ICHA’s groundbreaking team of volunteers, and we’re going to start off with a bang!
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ICHA: Coming of Age |
So much to write about these days, I'm not quite sure where to start. I'll begin with those issues most pressing.
Namely: ICHA has it's first big fundraiser this week -- on Friday. If you haven't heard about it -- and we very much hope you already have --it's at the Museum of the African Diaspora on Mission and Third. Our team has been doing everything a young nonprofit can to get the word out, but still, it's an uphill battle to cobble together the foundation of support necessary to make this organization what it could be. We hope you can join us -- it is absolutely essential that we have a good turnout, and filling a whole museum is a daunting task.
On the other hand, daunting tasks are what we do. We were featured in a local SF blog this week: http://iliveheresf.blogspot.com/2009/09/icha.html. Although the blog typically profiles individuals, Julie -- master photographer of i live here -- kindly agreed to profile ICHA as an organization. She took a gorgeous snapshot at our BBQ last weekend and, there we are (or some of us), along with our story.
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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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