Heart to Heart

The ICHA Blog

An Open Letter to ICHA by Nikka Rapkin on September 28, 2009 | 4 comments

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.

~~~~~~~~~~~

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.

I came to Elmina knowing that I would have preconceptions challenged and assumptions undermined. It’s happening and it’s true, but not in the way I’d anticipated. For me, at least, the greatest surprise has been the underscoring of how essential this work is. I was expecting to be overwhelmed by such a panoply of need that CVD would feel like a pathetic, impotent drop in the bucket. There is poverty here, blatant malnutrition (though apparently rates of hypertension exceed rates of malnutrition in Ghana – this is a statistic I did not know till yesterday) and tremendous need. We’d been saying, for so long, that cardiovascular health addresses poverty, removes a roadblock to infrastructure development, keeps parents alive and children fed – I’d began to fear (maybe always feared) it was just schtick. But, apparently it does.

We’ve only been here two days, really, (if you don’t count the jet lagged delirium that was Sunday) but it’s been an incredibly long two days. Sujatha is moving mountains with her teaching program. Prepared and hoping to teach approximately 10 folks from the clinic in Elmina, she was confronted with her first unexpected development fifteen minutes before day one of teaching was to start. The clinic director decided our program was important enough to bus in health workers from all over the district. We wouldn’t be training ten. We’re training almost forty. Talk about impact.

Fortunately, our clinical teachers are amazing. We are beyond fortunate in having them here. They are tremendously talented, patient, perceptive, and committed, excited about the program, figuring out how to connect with the health workers and turning ICHA’s program into their own. Every evening, we have dinner and discuss how to make the programs better, an honest evaluation of our effectiveness and a search for answers to the hard questions – many of the same questions that have been plaguing us since day one, but now we have an opportunity to see the issues in motion, to see what can be done and do it. 

The Community Program team has been instrumental in getting some of these questions answered as well as laying down the groundwork for their own mission. Are there culturally appropriate alternatives to salt and palm oil? Will people care about cardiovascular health in the face of the challenges of daily life? The answers so far have been yes, and everyone, teachers, trainees, clinic officials, community members – everyone we’ve spoken with is deeply engaged in making this program work. Most everyone by and large is friendly and welcoming – with adults there is a “secret” handshake (you snap each other’s fingers at the end), with children there is waving and calling out “hello Obuni [white person], how are you? What is your name?” Whenever we pass. Children also give us high fives when we walk by and yesterday a little girl insisted I try her fried bread (it wasn’t bad). Our contacts and new friends have been overwhelmingly accommodating, helping us get the information we need, scheduling meetings with the chief and queen mother, explaining the layout of the community and, time and again when we thank them for their help, we are told directly and in these words, “I help you because I want to help our people -- you are here to help us help our people.” Yes, but who knew that we actually could????

We all want to believe that the work we’re doing is important. I came to Ghana fully prepared to find out that it wasn’t. You guys – ICHA’ers and anyone else who finds themselves reading – I’m telling you, the work we’re doing is huge. It’s meaningful and I think it’s going to last. Obviously this is just a beginning. But, what a beginning.

Warm regards (though frankly, this humidity calls for cold ones),

Nikka