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SSL Session I: Vision Screening

Primary classrooms in Humjibre may each have more than 40 students. These dimly lit spaces, furnished with little more than a blackboard and rows of desks, offer little support to Humjibre’s students. Students are arranged by height order. Those that cannot see their teacher or the blackboard simply do not learn.

Rolling E Charts were preferred to the Snellen variety since they do
not require alphabet knowledge.

 We have just completed our first Summer Serve and Learn session in Humjibre. This session, Vision Screening, performed by volunteers and students from University of Texas Houston’s Medical School, focused on identifying and correcting visual problems in school-aged children. Volunteers also got to experience life in Humjibre and all regular GHEI cultural activities.

GHEI’s common theme of local and global collaboration quickly became apparent during this session. Before screening any students, volunteers worked together to teach each other and our local staff how to properly conduct various eye tests and what kind of problems they should be looking for. Our days were planned as a group and decisions were made by consensus. In conducting the actual screenings, since all GHEI staff and volunteers knew each test, they were able to easily interchange positions and seamlessly move about the screening sites.

Registering students and conducting screening tests at D/A Primary

Our first screening day was at Humjibre’s District Assembly Primary school. At a cool playground area under some trees, we set up a registration table, an area for eye tests, and three Rolling E charts. It was a scene reminiscent of countless outdoor medical clinics in Ghana and other developing countries. Starting from the Primary 1 (P1) classroom, students were brought to the registration table in small groups to receive their cards they would carry throughout the screening. They then moved on to one of the three identical first screening stations, each led by a volunteer.

The vision program came about through the suggestion of
one our SSL alumni and the encouragement of local district officials.

The students were given two tests: the first required a penlight and three conditions to confirm that their pupils were equally round and reactive to light, and the second was used to identify strabismus. The students understood the tone of voice from our volunteers, but little of their English directions. To help explain the tests, each volunteer teamed with a local staff member; setting a trend that would be followed at every step of the process throughout our screenings.

Students were then sent to one of the three Rolling E charts to complete their next test. Afterwards, GHEI kept the completed cards, and the students went back to their classrooms. Using previously decided upon thresholds, students’ cards were placed in one of three categories: cleared, recommended seating change, or referral for a follow-up visit.

Anglican Primary students with their cards waiting to be screened

The screening process started slowly, but as we became surer of ourselves and fell into a rhythm, the teams became very efficient. The students, who were at first nervous in an unfamiliar situation, were calmed by the staff and volunteers’ confident and caring demeanor.

The next day we continued screenings at Humjibre’s other public primary school, St. Mark’s Anglican Primary. P1 through P4 students were screened at the nearby Humjibe Community Center.

In total, 293 students were screened. Each student’s results fell clearly into one of our three categories. Ninety percent cleared of any vision problems, nine had minor difficulties, and twenty were found to potentially have larger issues that would require a follow-up trip to the district optometrist.

GHEI staff visited the classrooms of those that had only minor problems to suggest changes in seating arrangements; placing those students with issues toward the front of the room.

Screening stations at D/A Primary

Those students that required a follow-up visit were split into two groups for trips to the eye clinic at the district capital, Bibiani. While GHEI was not able to cover all costs of treatment, we did help families cross initial barriers. We escorted students to the doctor’s office, providing transportation and negotiating their first visit. GHEI also helped facilitate the purchase of insurance through Ghana’s affordable National Health Insurance Scheme.

SSL Vision Screening and UCLA Soroano volunteers and local GHEI staff

Five students were found to need glasses, two were referred to other clinics and several others were found to have infections which are now being treated. Glasses will be provided to all five students by GHEI and the Vision Screening program.

Local opinion of the program is very positive. Students’ parents and those at the district clinic have praised GHEI staff and volunteers for their efforts in offering vision screenings and facilitating treatment. Both those involved locally and our international volunteers recognize that this is a two-week program that brings immediate tangible results.

Evaluation of the project will continue through discussion and more quantitative measures. At first glance however, the Vision Screening project felt very successful and will likely be continued in the future.

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The Trip that Almost Wasn't: YLT

Youth Learning Tour 2014 almost did not happen. Just a few hours before we planned on leaving, our Education Program Manager received a phone call that the bus was broken. We had to postpone the trip. Then there was a hike in fuel prices and we no longer had sufficient funds to go.

Supreme Court

Since 2006, GHEI has been sponsoring an annual excursion for all of our Youth Education Program and Reading Club students. Youth Learning Tour is a highly anticipated and well-loved activity that provides many students with their first experiences traveling outside of our area. Unable to bear the thought of cancelling the trip, GHEI posted the last-minute fundraiser that ultimately allowed us to reschedule it.

As always, the night we left was a rainy one. Students arrived early, dressed well in neatly pressed uniforms, sporting their favorite coats and accessories. As they waited in the nearby Anglican Church before it was time to go, more and more people from Humjibre came to the roadside to see the students off. Families and neighbors of many of the students were present, as well as a group of GHEI Scholarship and former YEP students who had previously participated in the tour and many primary students who hoped to one day go themselves.

University of Ghana Legon Institute of African Studies

When the bus finally left, the songs began. Led by some of the older students and GHEI staff, the students sang and clicked thumb instruments for the first several hours of the ride. They worked through their repertoire many times and would have been happy to continue until GHEI enforced quiet for “compulsory sleep.”

A little before sunrise, the bus pulled onto the University of Ghana’s main Legon campus at the northern end of Accra. As students woke up, they stepped outside and got their first glances of the school’s immaculately landscaped colonial campus. The day’s first stop included guided tours of the museums at the Institute of African Studies and Department of Archaeology, where students were shown artifacts from West Africa’s rich cultural history.

Terminal at the Accra International Airport

Moving on, our next stop was a tour of the Accra International Airport. Students were brought through immigration and security to the terminals where they could view planes loading and taking off outside. This was a very new sight for Humjibre’s students and when it was time to go, many of them had a hard time leaving the window.

Transitioning to a more traditional field trip venue, we next went to the Supreme Court. The students were given a tour by a particularly interesting and humorous law librarian. They learned about the Court’s history, different courts in Ghana, and types of cases that can be tried. After the Supreme Court, we went to the Accra Sports Stadium. The stadium tour included the tennis courts and a gym for indoor games. A table tennis tournament was underway. Afterwards students were brought down to the national football pitch where they learned about Ghana’s team, the Black Stars, and were given a talk by the engineer who designed the pitch.

Accra Sports Stadium

Finally, it was time for the much anticipated last stop. We walked the last few blocks from the Sports Stadium, across the street, past Ghana’s historic Independence Arch, through Independence Square, to the beach. Many students stopped at the top of the last hill before the water’s edge. In either direction, the coast extends as far as the eye can see. In front of us were clouds, the sea breeze coming in, and the Atlantic Ocean. As their surroundings sank in, many students ventured down to let the waves roll over their feet for the first time. It was early Friday evening and the beach was a popular place, for countless students from nearby schools, photographers, food vendors and others. Many of our students took advantage of the photographers and got their pictures printed posing by the water.



Almost everyone agreed that while the other stops were more educational, the beach was by far the highlight of the tour. Sandra, one of our Form 3 students, who has now been on three GHEI Youth Learning Tours, explained that this one was her favorite because the two previous tours did not include a chance to touch the ocean. Although they live in a coastal country, most Humjibre students have never been to the water. This first interaction was exhilarating, awe-inspiring and reminded students of the opportunities that lay in front of them.

After an exhausting day, it was time to find something to eat and head home to Humjibre. In just a little over 24 hours, the students traveled from Humjibre to Accra and back. Their trip included a diverse range of stops on the way, learning about higher education and culture at the University of Ghana, the wonders of aviation at the airport, government and history at the Supreme Court, athletics at the Sports Stadium and, all of the glories of the beach.



Each year GHEI hosts a Youth Learning Tour excursion to a different location in Ghana. This year, the tour would not have happened without the help of those who supported us. Boarding the bus to travel home, it was clear that we pulled off a near-perfect trip that our students will not easily forget.

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Traditional Birth Attendant Training 2014

Traditional birth attendants learn their skills through on-the-job experience and the advice of old songs passed down to them by their mentors. Working with GHEI and our partner UCLA pediatric residents, their trainings are rooted in discussions emphasizing an understanding of the local context and how to work best within it. Being realistic is a priority in encouraging better healthcare and the use of modern practices and facilities while simultaneously acknowledging local resources and desires. Traditional birth attendants are key healthcare providers in this community and last week, proved themselves to be extremely capable.

GHEI welcomed back local traditional birth attendants for a refresher training and continuation of the pilot we started last year. The goal for this year’s training was to refine our curriculum to more closely reflect the needs of the local community. UCLA pediatric residents Jay Joo and Andy Newcomer led the program, working to keep the training’s focus on the most appropriate topics.

Familiar faces entered the room and proudly came around to greet each of us there. It was the same women who attended our training last year, and they were clearly excited to be back. Traditional birth attendants are part of a long-established practice that is still commonly relied upon. They learn how to deliver through apprenticeships, and now for the second year, have worked with GHEI staff and UCLA pediatric residents to broaden their education. Our training is focused on administering neonatal resuscitation, identifying danger signs during a delivery, and most importantly, knowing when to refer to a health facility. Based on conversations throughout the training and an oral evaluation the women took at the beginning, it is clear that last year’s training was successful. The TBAs retained a lot and had even incorporated much of it into their practice.

Cards distributed to the TBAs early in the training

Our trainings work to genuinely integrate the knowledge and resources of two very different groups to improve health. The residents spent a lot of time asking the TBAs questions like “have you ever referred a woman to the hospital and she has refused to go?” They opened the conversation to better understand the position of the TBAs, then tailored their lessons accordingly. They created a workshop environment that fostered a fruitful and productive discussion about how to best attend to home births in a place like Humjibre.

Similar to last year, they had few difficulties communicating, joking around, and learning to trust each other. At one point, Andy held the doll low and asked one of the ladies “What if the arm comes out first?” She shook her head and waved her hands as if to say “I don’t want it!” Jay chimed in “That is correct. Refer!”

There was discussion of not training the TBAs on using the bag and mask to stimulate breathing. This piece of equipment is needed in about one in ten births, and many of the TBAs only do a couple of deliveries each month. They will not need the bag and mask often, and may never fully be in practice using it. However, without any prompting, every TBA showed up to the training with the bag and mask she was given last year in hand. Not everyone had used it, but they always kept it ready and many were excited to share their experiences with it in the past year.

The women paid close attention during their bag and mask refresher training, and then each took turns acting out what they would do in various scenarios presented by the residents. The TBAs each knew their procedures well, and according to the residents, could “use the bag and mask as well as anybody.” At the end of each scenario, a small noise maker was used to imitate crying, signaling that the baby was properly breathing. Each first set of squeaks from the noise-maker was greeted with a smile and cheers from around the room.

A few weeks ago we blogged about GHEI’s new Health Facility Delivery Incentive Program which is designed to increase skilled birth attendance and facility-based deliveries. This program is designed to draw women away from home deliveries and the use of TBAs. If nothing goes wrong, a TBA can provide a comfortable, caring and affordable delivery. However, TBAs are not well prepared to handle complications and there is never an ambulance waiting nearby. In 2011, about 33% of deliveries in our region of Ghana took place in the home, according to the most recent survey.[1] With such common use of TBAs, the two programs complement each other; GHEI encourages delivery at a health facility, but also provides for the best possible care for those women who will inevitably choose to deliver at home.

Be sure to check out our Facebook where more photos will be posted in the next few days.

[1] Ghana Statistical Service, 2011. Ghana Multiple Indicator Cluster Survey with an Enhanced Malaria Module and Biomarker, 2011, Final Report.

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Update on World Malaria Day: the Kojina Sweep

As we reported last week, GHEI celebrated World Malaria Day 2014 a different way in each of our malaria prevention catchment communities. Each event was specifically designed to best match each community’s individual needs. The final event, World Malaria Day Kojina, took place yesterday.

There was no large presentation in Kojina. Rather, GHEI community health workers (CHWs) split up to conduct follow-up visits in each Kojina home. They reached the majority of households, and offered demonstrations and personalized flipchart education to each family they met. The CHWs also carried extra bednets to sell at GHEI-subsidized prices.

5 Steps to a Successful Follow-Up Visit

1. Find the house. As a CHW, your first task is to consult your house list and determine where you are going. If you do not know the house, you will have to ask around to find it and the people who live inside.

2. Check bednets in every room. Introduce yourself then ask how many sleeping sites and bednets are in the household. After this, check every room and take stock of the nets you find inside. Next, go back and hang or rehang any nets that are not properly hung, and using a needle and thread, mend any tears. Invite household members to join you and explain the steps you are taking.

3. Ask for a demonstration. Ask a member of the household to show you what they do with their net before going to bed. Make sure they are properly tucking the net into their sheets or that the net touches the ground, ensuring that mosquitoes cannot get inside.

4. Offer education. Sit down with everybody present and go through each page of your bednet usage and care flipchart. End the session with a discussion and give everybody the opportunity to show their knowledge and ask questions.

5. Voila! Your follow-up visit is complete. Every bednet in the household is ready, and every person is motivated and knowledgeable about proper use and care.

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World Malaria Day 2014

Malaria, the leading cause of global morbidity and mortality, is both preventable and treatable. Thankfully, heightened awareness and global efforts to fight the disease have led to recent progress. Since 2000, malaria incidence in Africa has decreased by 31% and mortality rates have reduced by 49%.[1] For an in-depth look at malaria prevention and treatment in Ghana, check out the WHO Ghana Fact Sheet.

The best way to reduce malaria at the community level is considered to be vector control through the use of long-lasting insecticidal nets (LLINs) and indoor spraying with residual insecticides. These methods stand out for their ability to bring malaria transmission from very high levels to close to zero.[2] GHEI’s Malaria Prevention program focuses on promoting of the use of LLINs, or bednets.

A common problem with bednet interventions is that owning a net does not always translate to sleeping under a net. There are many reasons why bednets are owned but not used; including heat, discomfort, inconvenience and lack of knowledge of how to hang them. To help overcome these barriers, GHEI community health workers work with household members to initially hang bednets, then offer in-home small group education on bednet use and maintenance and finally, complete follow-up visits to periodically check-in on household bednet use.

For World Malaria Day Humjibre, GHEI held a classic celebration and educational outreach program. The evening began with general education on malaria, bednet use and proper care, and a talk given by a nurse from the Humjibre Health Clinic on malaria symptoms, treatment and prevention for pregnant women. Afterwards, three short dramas were expertly performed by GHEI staff, community health workers and volunteer teachers on the importance of bednet use for pregnant women, children under 5 and seeking prompt treatment.

One of the highlights of the evening was a screening of the Fufu Films original, United Against Malaria (2010). This vintage GHEI film was locally produced and starred our very own GHEI health team and community health workers (many of which are still with GHEI). Taking place in Humjibre, the film was perfectly relatable for the audience and fun to watch.

The program was presented in Sefwi so that everybody could understand. After a rainy weekend, attendance at the event was relatively low. GHEI normally enjoys a great level of community support but, like other organizations offering interventions, has to grapple with the dilemma of how to keep everyone interested. Those that did attend the event came completely on their own will and were pleased to participate.

With the goal of presenting a program to meet the specific needs of each of our catchment communities, World Malaria Day celebrations were different in both Kojina and Soroano. A bednet sweep is planned for World Malaria Day Kojina. GHEI’s health team and community health workers will visit homes throughout the small community to inspect bednets and offer education. In Soroano, the community recently held a clean-up day to help beautify and remove mosquito breeding grounds. Following the success of World AIDS Day in December, Mensah lead a World Malaria Day discussion over the Public Information System and commended everyone in Soroano for doing their part in protecting the community. The talk was well-received and afterwards, some students even came to Mensah to collect new bednets to bring to boarding school.

GHEI is a dynamic organization, and is constantly working to improve our programs and outreaches to best fit the changing contexts of our communities. By promoting bednet use year-round and adapting global events like World Malaria Day, we are doing our part to help defeat malaria.

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[1] World Health Organization, World Malaria Day, http://www.who.int/campaigns/malaria-day/2014/event/en/ (28 April 2014).
[2] World Malaria Day.

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Healthy Mothers, Healthy Babies

This weekend, we will welcome a new set of UCLA Pediatric Residents to Humjibre. They will be implementing a training program for local traditional birth attendants.This is one of two programs begun this past year, by GHEI, to encourage safe deliveries and improve child and maternal health.

While Ghana has made significant progress toward meeting many of the Millennium Development Goals by 2015, progress in MDGs 4 and 5, reducing child mortality and improving maternal health, is still relatively lagging[1]. One way to foster improvements in these areas is to increase skilled birth attendance and facility-based deliveries. GHEI’s trainings in partnership with UCLA and our new Health Facility Delivery Incentive Program (HFDIP) do just those things.

Our annual evaluation survey found that in Humjibre, where one of only a few health clinics in our area is located, about 25% of deliveries over the past five years still occurred at home. Even though pregnant women are exempted by Ghana’s Ministry of Health from paying prenatal care and delivery fees[2], providers still generally collect a fee from women in the form of supplies necessary for delivery. To help offset this cost, HFDIP provides expectant mothers with the most commonly collected supplies.

Every other week, we open our doors to women who are six months or more pregnant to hand out incentive packages, offer education on safe delivery, and administer a short survey. After delivery, we follow-up with women to find out where they delivered and why. We give them a baby blanket as a thank-you for returning.

This program has proven to be extremely popular. Since it was launched in November 2013, 122 women have participated in the first survey and 45 have returned post-delivery. Considering the total number of births in Humjibre over the course of a year, we estimate that almost all expectant mothers are electing to participate in the program.

When asked about the package during the post-delivery survey, many women stated that the package “helped a lot” and “limited expenses.” One explained that she “was benefited because the clinic collected the incentive given to me [by GHEI] and one of each of the items remained.” Another told a story, saying that “[The package] helped her a lot because she came for the incentive and, after one week, went to deliver. If not for our incentive, she would not have had anything.”

While it is still too early to tell if this program is helping significantly more women choose to deliver at the clinic, there is no doubt that women appreciate it; and it is helping them get the supplies they need to more safely deliver.

[1]United Nations in Ghana, Millennium Development Goals in Ghana, http://unghana.org/site/index.php?option=com_content&view=article&id=81&Itemid=448 (24 April 2014).

[2] Ghana Ministry of Health, Guidelines for implementing the exemption policy on maternal deliveries, Report No. MoH/Policy, Planning, Monitoring and Evaluation-59. 

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Staying Involved: GHEI Champions

GHEI has finished recruiting for its 2014 Summer Serve and Learn sessions and is excited to welcome new volunteers for the Girls’ Empowerment and Malaria Prevention sessions as well as the new Vision Program. Behind the scenes, we formed a core group of alumni volunteers to assist with the recruiting process, spread the word about our summer programs, and raise awareness about GHEI. These GHEI Champions were integral in our outreach efforts.

Did you see our catchy #ThinkGhanaItsFriday hashtag during our initial call for applications in November? Or the thoughtful reflections about GHEI in The Power of Education by Dan Doverspike and Mike Kacka’s thoughts about volunteering? Maybe you go to school with one of our volunteers and saw their GHEI presentation? These personal accounts through various mediums and forums allow volunteers to stay connected to their GHEI experience while sharing their stories with potential new volunteers. We wanted to frame our recruiting efforts as a bridge between alums and new volunteers having dialogues about international volunteerism and its impact on one’s personal and professional development. GHEI gives our volunteers the space to utilize their broad skillset and creative energy to share their GHEI experiences.

The concept of GHEI Champions developed from this desire to give volunteers returning home from Ghana a flexible way to continue their involvement in GHEI. We developed quick actions for volunteers during our social media day and GHEI topics to explore while connecting with personal networks. We have this blog for volunteers to share their thoughts! And we are open to new approaches to raising awareness and starting conversations about GHEI’s programs.

We have all had that out-of-sight, out-of-mind experience, but volunteering abroad does not have to be a one-off experience once we get home. What do you think? How would you like to stay connected?

GHEI is always looking for feedback to improve. Please feel free to reach out, share ideas, and get involved! (communications@ghei.org)

Best wishes,
Susan & Elena

Thank you to our GHEI Champions for helping to shape this year’s recruiting efforts!

Alex Borchardt, Amy Silvia, Anna Rosenbaum, Dan Doverspike, Doug McKechenie, Elizabeth Raine, Emily Huang, Helen Baleng, Jasmine Kwon, Leah Ratner, Maria Renwick, Matt Galek, Mike Kacka, Natalie Rich, Salin Nhean, Sarah Gustafson, Sidra Khalid, Sophia Wang, Tabatha Norton, and Tamara Mason

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CHWs Working Together to Protect from Malaria

GHEI relies on dedicated community health workers (CHWs) to not just uphold strong relationships with our local population, but to make GHEI's Malaria Prevention program possible. In the last seven months, GHEI CHWs have performed follow-up visits surveying a total of almost 400 households, representing more than 3,000 individuals. At their recent two-day retreat, they came together to go over the follow-up visit process, learn new skills, increase team cohesiveness, review accomplishments and consider challenges over the past year.

Our CHWs are comprised of a balanced mix of men and women of varied ages, who come from different areas within their communities. They are a diverse group; and together they are trusted by a large population. Yaa Mary is a veteran CHW who has been with GHEI for many years. Speaking with her before the retreat started, she mentioned that she enjoyed being a CHW: saying that it is good work but also gives her an important skill. Yaa Mary has increased her knowledge about healthcare and knows how to protect her family from malaria.

 GHEI CHWs normally work alone. They are given a list of houses to conduct follow-up visits on; making sure bednets are properly mended, hung correctly, and everybody in the home knows how to use them. The retreat gave them an opportunity to talk shop. They considered challenges they’ve encountered, possible solutions and shared their individual best practices during follow-up visits. These were lively conversations where almost everybody was sharing their thoughts on each previous contribution.

In an effort to improve our Malaria Prevention program, the CHWs’ follow-up visit protocol has changed in the last year. Early on in the retreat, everybody worked through two sample follow-up visits. The health staff acted out various scenarios during a home visit, while the CHWs all filled out their forms, then came together to make sure that they agreed on the same result. They practiced their new protocol, identified potential problem areas and decided upon solutions.

 On the second day, they took a trip to the capital of our district, Bibiani, to learn more about malaria and the parasite that causes it. Once there, they started the day with a challenging game of Malaria Jeopardy. At the district hospital, they met Sargent Doe, a good friend of GHEI’s, at the blood lab. The CHWs were given a tour and a demonstration of the lab’s malaria test. Everybody got the opportunity to inspect both healthy and malaria-ridden blood through the microscope and learn how to differentiate between the two. While no GHEI CHW will be performing blood tests anytime soon, the lesson increased interest in malaria prevention and each CHW’s confidence in educating the population against malaria.

Even after a tiring couple of days, the retreat left everybody refreshed and motivated. When asked what their goals were for the next year, many answered that they wanted to commit themselves to their work, because as Soroano CHW Yaw Ntori put it, “If we use all the skills we’ve learned here, we can get rid of malaria.”

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"Free Forever"

This was how Kwame Nkrumah described Ghana when he first declared independence on March 6th, 1957. His country was the first independent nation amongst former colonies in Africa, leading its peers by calling for freedom, justice, equity, and Pan-Africanism. Today, Ghana boasts a stable, multiparty democracy and continues to be a leader in development.

Students from Humjibre have been preparing for 6th March all week; practicing their marching, salutes, and cleaning and pressing their uniforms so they can look their very best on Independence Day. Even in the evenings, children constructed makeshift drums to try their hand in hopes of someday leading the march. On the day of independence, everybody in town came out to see the students from the four local schools; District Assembly, Anglican, Wireko Memorial and Deeper, perform.

Festivities began with students marching from the Anglican church through town to the football park.

A local band led them in their steps.

Once students from all the schools arrived at the park, Assemblywoman Madam Janet began with a speech.

Each group of students then marched by and saluted. Even the youngest nursery students took part. Some of these students required extra coaxing to stay in line.

Each group prepared a march and different salute to show to the crowd. Wireko Memorial boys marched like soldiers.

District Assembly boys took a knee to salute.

Deeper girls gained approval by saluting with a popular dance style.

Deeper girls saluted with a Ghana flag.

Anglican girls saluted with a sign that read “Peace.”

Students were not the only group to take part in the march. Farmers and other groups joined in at the back of the line to represent the important contributions they make to their nation.

Ghana’s Coat of Arms as posted in the Soroano Public Information Services office.

To learn Ghana’s national anthem, click here.

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