TBA Pilot Training and the UCLA Peds

It’s a muggy morning, you’re waiting. Not yet, but something at the community center is slowly taking shape. It’s the beginning of a two-day pilot training for traditional birth attendants (TBAs) by the UCLA pediatric residents Grace Deukmedjian, Mary Limbo and Michelle Aguilar. They posed the question early on: “What can you do to improve health in your community?”

One woman raised her hand and asked: “If there isn’t a car, what can we do?” TBAs are busiest in resource-poor environments. When there is not a health facility present- these are the women that expectant mothers turn to. They are well-experienced in delivering babies, but lack the same education and training that nurses and midwives have. A large part of their training is knowing when to refer women to better equipped health facilities.

Theoretically this works. Except places where TBAs deliver babies are places that do not have cars. This question prompted our residents to acknowledge an important point. We are in a rural village, births do not always go according to plan, and the situation will rarely be ideal. In this environment, the goal of the TBAs remains the same: do everything you can to protect the health of the mother and the baby.


For now, the best way to achieve this goal is preparation. Many of the area TBAs came. They were older women, each dressed in traditional fabrics with colorful intricate patterns and lively facial expressions. They chimed in with thoughtful questions and waited expectantly to see what their colleagues (Ghanaian and American) had to say. Many of the women nodded along and you could hear the occasional “mhmm” and “ehhen” in agreement. They are a group of women who care deeply about their patients and want to do everything that they can to best serve them.

There was no sense of privilege or superiority. This was a meeting of people who care for infants; cooperating and sharing their best methods. A translator was often needed, but the conversation flowed freely as the women discussed their experiences. Lessons evolved during the training and were tailored to respond to the questions raised by the participants. When the TBAs were split into small groups for skills practice, smiles and cheers erupted from each station from time to time, marking a newly breathing “baby.”

The residents have been in Ghana for about three weeks and have been extraordinarily busy. Beyond the pilot TBA training focused on neonatal resuscitation, clean delivery, and guidelines for referral, they have also been responsible for refresher trainings for area nurses and midwives. The residents are packing in way more than they anticipated, but simply explain their obligation: “Since we’re here, we’re gonna do it!”

After the TBA training finished, each woman was given a new kit of supplies and some minerals to drink (the TBAs all chose Sprite and residents all chose Coke). The pilot’s lasting impact is yet to be seen, but the TBAs have each found easy changes they can make to better their practice. If you can improve your ability to safely deliver and care for babies, you can improve health in your community.

To see more pictures from UCLA trainings, be sure to check out our Facebook where they will be posted on the 16th!

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Back to Humjibre, the "Resting Place"

The following is a guest blog written by Emily Wei, one of GHEI’s founders who recently returned to Humjibre for a short visit.

A few months ago, I arrived back in the village I once called home, eager to see old friends, colleagues, and students. In 2003, Ghana Health and Education Initiative was just a name, an idea, and a few people who wanted Humjibre to become a place where brainy students could go to school despite financial limitations, families could outdo the scourge of malaria, and community members contributed to make it all happen. Now, in 2013, in its tenth year of existence, GHEI and Humjibre are flourishing. On the land we were gifted by the community now stands not only the community center that I was privy to seeing built (not without struggles, and sadly a death of our engineer who the center is named after), but offices, a computer room, a library and ample volunteer housing space. The center is truly that, located at the center of the village, and a place for people to congregate, learn and hopefully, be inspired. I know in my short stay back in Humjibre and hanging out with some of the GHEI family, I certainly was.

Emily & Ernest

With ten years past, what struck me is not only how GHEI is flourishing as an organization, with a multitude of programs that we did not have when we started, and local and international staff that are incredibly dedicated and professional, but moreso, how past GHEI friends and participants have now become leaders in the community. I saw Ernest, now a full time teacher with GHEI, who when we first arrived, would come to our house all the time (which doubled as the first office) to read, talk and hang out. He has become an incredibly disciplined, well rounded, and might I say, fashionable young man who is now contributing greatly to the community, his family, and our work. Then there are those who have been the steadfast leaders who have been with us since the beginning- Clement, who continues to lead the work of GHEI and Sister Comfort, who hasn't missed a step in caring for GHEI international staff as though they are true Humjibrians- born and bred.

Emily & Sister Comfort

And maybe most inspiring was to see and hear about past GHEI students who are now teaching with GHEI and giving back to their community. Some of them are even aspiring to go abroad to study, to further their educations and broaden their experiences. Their path forward is only a reminder of how important the work GHEI is doing to encourage, strengthen and uplift those who just need a little boost to reach their goals and meet their incredible potential.

Clement, Emily, Mensah & Aggie

I look forward to coming back again (hopefully without letting 8 years pass by again) witness what other great things Humjibreans will do. But perhaps much sooner, Humjibreans will come visit us, the GHEI family, spread out around the US, Europe, Australia, Asia and Africa!

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World Malaria Day, Part II

Coming back from Kojina, we realized we had done it. Three nights and three World Malaria Day events: on Wednesday in Humjibre, on Thursday in Soroano, and Friday, in Kojina. Back in Humjibre, setting up a whiteboard for the projector and watching the children dutifully put out plastic chairs for the audience; I had no idea how big these were going to be.

Each night, the program started with a DJ playing some music. After an opening prayer, the health team began with a presentation to educate the community on malaria symptoms, treatment and prevention. They used different speakers and a mix of videos; some starring the Humjibre community health workers (CHWs) and some funny animated ones (thanks to  Scientific Animations Without Borders!). Local CHWs and nurses were then introduced and the team opened the floor for a community discussion and Q&A.








The program was designed to reach participants of all ages. Sections like the bednet cost analysis were aimed for adults, while toffee for correct answers enticed children. Community members were engaged and excited to be there. As a newcomer to G.H.E.I., it was very cool to see the events organized and taken in with such energy by these rural communities.

Each night, there were more youths that attended the event than adults. One of the Soroano CHWs, Yaw Ntori (Original) said that he particularly enjoyed when young children correctly answered questions to showcase what they learned. His comment touched on one of the vital roles of the youth in communities here. When G.H.E.I. teaches children, they bring that information home and teach families.

Audience participation during the cost analysis, discussion and Q&A sections was striking. Starting with the cost analysis, the health team presented two scenarios: either pay to buy a subsidized bednet now, or pay for malaria later. Our very own Clement Donkor and Mensah Gyapong became celebrity emcees and asked for the audience’s help to estimate the price of costs like travel to the clinic, medications and missed work. People shouted hoping to see their own guesses come up on the projection. After all the costs had been tallied; it was significantly less expensive to buy a bednet now than risk malaria later.

For the discussion and Q&A sections, the emcees roamed through the crowd choosing contestants for a chance with the microphone. Once each speaker was chosen, everyone else listened attentively then cheered and clapped for them after they finished. While many people made jokes, others demonstrated what they learned.

The health team worked hard to prepare for World Malaria Day and they thought that by Friday running the event would be easy. But the afternoon brought a rainstorm, so the evening was cold and after a busy week; many people wanted to stay home and rest. However when the DJ turned his speakers on, the community came out. It was late, and it was cold in Kojina- but we finished strong with a large and engaged crowd throughout the whole event.

Be sure to check our Facebook page: https://www.facebook.com/GHEI.Ghana for more photos from the event!
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World Malaria Day, Part I

Living in Humjibre, pesky mosquitoes and the diseases that they carry- namely malaria- are a daily concern. It is estimated that around 3,000 children die of malaria every day worldwide. However for some people, the problems posed by malaria will rarely cross their minds. What is most surprising about this contradiction is that malaria is a completely preventable and treatable disease. To help raise global awareness and mobilize communities worldwide; April 25th, 2013 has been set aside as World Malaria Day.

Malaria is hyper-endemic in Ghana, with the entire population of 24.2 million at risk. While there have been many initiatives in Ghana to increase public understanding and access to effective methods in combating the disease, it continues to be a large issue. According to the Bibiani-Anwhiaso-Bekwai District Health Information Unit, malaria accounted for almost half of all outpatient cases and more than a third of admissions in the district where GHEI operates in 2011.

Here at GHEI, our Malaria Prevention Program focuses on increasing the use of insecticide treated bednets (ITNs) in Humjibre and its surrounding communities. This method is considered to be relatively very effective in decreasing the prevalence of malaria. Our program uses trained community health workers to assist families in hanging bednets, and then offer in-home education and monthly follow-up visits to ensure continued proper use.

This year for World Malaria Day, GHEI is presenting a series of outreach programs in Humjibre and the neighboring communities of Soroano and Kojina to support public education of malaria symptoms, treatment and prevention- with a focus on bednets.

Be sure to check back soon for Part II of this blog to see this year’s GHEI World Malaria Day outreach programs!

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Sources:

President’s Malaria Initiative. 2012. Malaria Operational Plan–FY 2012 (Year 5). Ghana.

Shiner, Cindy. "Malaria - Keeping a Crafty Killer On the Run." allAfrica.com. http://allafrica.com/stories/201304250108.html?aa_source=slideout (accessed April 25, 2013).

Akwaaba! (some things never get old to hear)

I have been in Ghana for just a few days and nothing is more striking here than the friendliness of the people. Arriving in Humjibre, I was immediately made to feel at home. Between the staff at GHEI and the organization’s countless friends in the community, I have already met so many people who I feel comfortable talking with and am happy to consider my friends.

My first impressions of GHEI showed that it is a well- valued organization that is deeply integrated into the Humjibre community. To me, something that stands out about GHEI is that its core is comprised of local staff who are truly invested in the village. On a tour, I was able to see many of the staff members’ family homes and realize their lifelong relationships to Humjibre. As a Westerner joining the organization, I am thankful for the opportunity to learn from the people here.

Cheif Nana Twum II, Adrian, Myself and some of the Village Elders

 Joining the local community, one of my first activities was to go and meet the chief. Walking into the palace, many of the elders were already seated. I followed the delegation that joined me from GHEI in shaking each of their hands several times before we were then seated to begin. The mission of our visit was to allow the chief to say thank you and goodbye to Adrian and then welcome me to the village as his replacement as GHEI’s Communications Officer.

When a Ghanaian says “you are welcome” they mean it. The chief assured me that my work would be valued in my new position at GHEI and offered my protection in the village. I was even promised that if I ever had any difficulties I could go to their council for help. While we were in a formal setting, I could tell that everybody there was extremely hospitable and this would be an approachable group of people.

These kids would have posed for photos all day given the chance

Feeling so welcomed has had a powerful meaning for me. With the chief’s assurance and faith that has been put in me by everybody that I have met here, I am sure that I will be able to fulfill my role and positively impact GHEI’s program. I have heard before that the people of Ghana are the friendliest in the world, but the people of Humjibre may be the friendliest in Ghana.

Happy and I ran into some of our other staff Saga and Shantie during my village tour

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The Need For Community Health Workers

Why are community health workers needed? Because there simply aren't enough highly trained medical personnel, like doctors and nurses, to meet the health needs of everyone living in sub-Saharan Africa, including Ghana. Several factors are at work to create this deficiency. Medical training is long and expensive and medical training centers can't keep up with the demand, especially as populations grow. Many trained medical professionals prefer to work in the cities or to seek work in other countries where the pay is better. Furthermore, AIDS and other diseases have stripped the medical community of valuable workers.

Many of the previous blogs make mention of the Millennium Development Goals, which address the most pressing human development needs around the globe. Of the eight goals, three aim to improve human health by reducing child mortality (MDG 4) and maternal mortality (MDG 5), and by combating HIV/AIDS, malaria, and other diseases (MDG 6).

Ghana has serious needs in all of these areas, but never more so than for people living in rural areas, who may have quite a distance to go to receive any kind of professional medical attention and may be impossibly far from the nearest hospital. In many cases they are also too poor to pay for expensive medical services and medicines. On top of this, they may be fearful or mistrustful of leaving their homes and being attended by clinic workers they don't know.

One way to improve their access to basic health care is to provide the services of community health workers (CHW). A CHW is an individual from the community who is rudimentarily trained to provide basic health services, mainly to those who are under-served. Their services may include prenatal visits, post-natal mother and infant care, vaccinations, counselling on sexually transmitted diseases, and specialized programs like malaria and tuberculosis prevention.

The person may be a volunteer or may be paid a salary for their work. The advantage in having a local person fill this role is that they know the local customs and language, and are more likely to be accepted by the community than an outsider of the same standing. CHWs usually maintain their ties within their community and, with proper support, tend to stay with the job.  The people they serve typically trust them, and the CHWs have a respected standing in the community.

Through their provision of primary health care, CHWs contribute valuably to the whole community, but they are particularly important in improving the health of children. In the case of Humjibre and the surrounding communities, CHWs have been involved in every step of our malaria prevention programs, and their dedication has led to a marked rise in the ownership and use of insecticide-treated bednets.

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Sources

Global Health Workforce Alliance. 2010. Community Health Workers - Key Messages. http://www.who.int/workforcealliance/knowledge/resources/chwkeymessages/en/index.html

Lehmann, Uta and David Sanders. 2007. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. School of Public Health

University of the Western Cape. Report for the World Health Organization, Geneva.

Morrow, R.H. 1983. A primary health care strategy for Ghana. pp. 272-299 in Morley, D., J.E. Rohde, and G. Williams (eds.) Practising Health for All. Oxford University Press: Oxford. 272–299.

International Children's Book Day

Today is International Children’s Book Day and the GHEI Community Library is a hive of activity. It seemed fitting to have a quick chat with Library Administrator Lawrence Donkor on this special day:

How many children come to the library each day? 
Around 35 children come to the library on an average day, though some days it's more. It depends on their school schedule and any events that are taking place in the community.

What kind of books do you think the children enjoy the most?
They like to read picture books, especially by African authors. They like seeing pictures of the story, and it helps them understand. These books are relevant to the children – they’re culturally relatable. Some books from the West don’t make sense to the kids, but there are also lots of great books from around the world that the children love.

What children’s book would you recommend to teachers and parents?
Hmm (long pause). Caps for Sale! It’s about a peddler selling caps, roaming up and down the street, getting tired since no one will buy a cap. He falls asleep and wakes up and sees his caps are all gone.

It turns out monkeys from the tree he was sleeping under took them. It’s an interesting book, and when you read it to the kids they’ll all start laughing.

Thanks Lawrence!

Building literacy skills is a key element of our education programs here at GHEI. Reading skills will serve as the foundation for a student's entire academic career. GHEI is launching an internship program this summer that will pilot the expansion of GHEI’s Community Library programming to the rural community of Soroano. This new literacy campaign aims to increase primary and junior high school students’ ability to develop and employ literacy strategies through a school-based outreach.

Read more about this internship program here. Please help us spread the word about this exciting opportunity! 

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CHWs Retreat

Last Thursday, GHEI’s Community Health Workers (CHWs) took time out of their busy schedules to go on their annual retreat. GHEI’s health team and CHWs convened at the picturesque Queen Elizabeth Hotel in the neighbouring town of Wiawso to review the basics of their role in the communities they serve. This was a great opportunity for CHWs to refresh themselves on the best practises of their work, as well as strategize on ways to make their efforts as effective as possible.

The day started with some fun icebreaker activities that energized the group and had everyone laughing. Once everyone was thoroughly warmed up, the group began a discussion of GHEI’s malaria prevention programs. Everyone shared their own experiences in working closely with the community to ensure that everyone owns and uses insecticide-treated bednets, and this served as a chance for our CHWs to share their opinions and suggestions for the program. Following this was a workshop on follow-up visits, which CHWs conduct regularly to check up on families they have interviewed before.

At the end of a very busy morning, everyone was ready for a hearty lunch. The Queen Elizabeth is known for their tasty food, of both Ghanaian and international varieties, and our health team enjoyed such local delicacies as goat soup with fufu, as well as tilapia with banku. After a satisfying meal, it was back to work, with a discussion of both accomplishments and challenges of 2012-2013. This was an important component of the day, as sharing achievements really helps to strengthen the team dynamics, while discussing challenges offers the CHWs much needed support.

After a review session and a lively quiz competition on their in-home flipchart education used during follow-up visits, the day came to a close with a final wrap-up discussion that invited suggestions and questions, followed by a time for personal reflection and goal setting.

After a content-heavy day, our health team and CHWs were more than happy to unwind at the end with some well-earned beverages!

CHWs are crucial to GHEI’s health programming, and we are extremely grateful for their diligence in their work to promote malaria prevention in our communities.

Well done CHWs - keep up the great work!

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Humjibre Football Gala 2013

A photo essay by Lawrence Donkor

Last week, Humjibre held its annual three-day football gala, from March 13-15.  All of the primary and junior high schools in Humjibre and Muoho participated in the tournament, and every player gave it their best.  Football is very popular here in Ghana so the football gala is a very exciting time for everyone in the community.  Many people come out to support the players and cheer for their favourite team.  Here's a set of pictures taken over the course of the tournement:

Muoho JHS Girls (in yellow) against Christ Redeemer JHS Girls.

Christ Redeemer Primary School (in red) face Anglican Primary School.

The spectators gather together in the shade to escape the hot sun.

Muoho Junior High School boys team.

Christ Redeemer Junior High School Boys.

Muoho takes a penalty kick against Christ Redeemer.

The fans jubilating after Christ Redeemer scored their second goal, winning the game.

Watching football was a great way to spend my birthday!

In the end, Muoho JHS Girls were the winners out of the girls teams.  District Assembly Primary School won the primary school division, and Christ Redeemer JHS boys won at the junior high school level.

The tournament was a lot of fun for everyone, and I was very happy to spend my birthday watching football!

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International Women's Day

Today, March 8th, is International Women's Day. Under the theme of "The Gender Agenda: Gaining Momentum", women and groups all over the world are celebrating the progress being made in efforts to close the gender gap and are giving fresh thought to how we can build on this success and increase the momentum until full gender equity is achieved.

We at GHEI recognize that transforming the lives of girls and women can bring new hope to families and communities. In our work here in Humjibre and neighbouring communities, we strive through all our programming to encourage and support girls in their education and health and to provide teaching and discussion in which they learn to value themselves, set high goals, and take charge of their future. GHEI has been coordinating girls’ empowerment camps in Humjibre since 2006. Many girls have learned to articulate their goals and have gone on to apply for scholarships and pursue more schooling, finding a new sense of pride in themselves and what they can do for their community and immediate families. We also strive as an organization to empower females year-round by targeting girls in all of our education programs.

A new source of excitement in our programming is the upcoming launch in June of a brand new four-week internship program. The Rural Girls’ Health Project (RGHP) is a health campaign for female upper primary and early junior high school students in Humjibre. Through school-based education on adolescent development and hygiene, the campaign aims to empower girls to participate fully in social and academic activities.

Please visit our website to learn more about this opportunity, and help us spread the word to those who might be interested in participating in this compelling new program.
 

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