Malaria Program Evaluation Survey In Twi For The First Time

In the last few days, a large group effort has been taking place at GHEI…

The Health Team has been gearing up for a new season of surveying and has adapted into Twi the evaluation questionnaires to be implemented by Community Health Workers and then used to evaluate the success of GHEI’s malaria program. Carly Edwards, Mensah Gyapong, and Aggie Obeng have been meticulously going over each question to get meaningful translations that maintain the gist of the English question, but are phrased in a culturally relevant way. This task has also greatly benefited from the language expertise of Happy Nkrumah and Clement Donkor (and anyone else in the office) to offer suggestions. Here’s an example:

English: Can we enter your room so that you can demonstrate how you sleep under your bednet?

Twi: Me srɛ wo, wobɛtumi ama y’akɔ wo dan mu na woakyerɛ me deɛ wo yɛ wo ntontom dan no ɛberɛ a woreba abɛda no? (I beg you (Please), can you allow me to enter your room to show me how you do your bednet when you are sleeping?)

This new survey was presented to a brand new expanded group of CHWs this Friday. It was the third time in as many weeks that they had met for training on data collection in preparation for the new surveying missions. This month evaluation surveys are being conducted in Soroano and in July, the team will be conducting evaluation surveys of Kojina and Humjibre, with the assistance of the Serve and Learn volunteers from abroad. Because bednets have been distributed in three communities (most recently in Kojina), the amount of surveys to be implemented is larger, so training was extended to GHEI’s YEP and ECL program volunteer teachers, who rolled up their sleeves and joined the Health Team to become proficient in data collection.

With the final draft in Twi, the group met on Friday to discuss the next few weeks of surveying. What is the initial verdict on the survey?

Dickson, Ampenkrom’s new district assemblyman: “It will make a positive difference. It means people can express themselves better…and it makes my job easier!” Dickson is finding scheduling his CHW responsibilities difficult, especially in light of his new role in his community. “It’s difficult finding the time, but it is important.”

Yaa Mary, veteran CHW: “I have been a CHW for four years; this is the first time it is in Twi. It is my language, I can understand it better. It will help.”

Felicity, who teaches English in the YEP program, and received a senior high school scholarship through GHEI: “The training is fine, it is not too difficult. Now [that it is in Twi], it is easier to ask the questions.” So do you think you’ll switch over to the Heath side of GHEI full-time? “No, being a teacher is still my favorite! I want to continue to teach.”

So: the new survey, translated from English into Twi in many group discussions in GHEI’s office, will be carried out by community members from Soroano, Humjibre, and Kojina, who are involved GHEI’s health AND education programs. These trained interviewers will survey their own communities in Twi using the newly translated Twi questionnaires, while Serve and Learn volunteers from outside Ghana come to help them out. This is a global group effort, but one that seems like business as usual here at GHEI.

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"Look at my hands! They are clean!"

Since the introduction of polytanks to many of the schools near Humjibre, students have running water for cleaner, more effective hand washing. While the technology is there, without proper hand washing technique, hands will remain dirty, diseases will be spread, and children will fall sick.

The Muoho D.C. Primary School sits to the right of the dusty, pockmarked road between Humjibre and Bekwai. (Go here for a map of the Humjibre area) As you drive past you can often hear the high pitch chorus of recitations taking place inside the classrooms, even over the cacophonous rattle of the taxis streaming by. It was here that the GHEI health staff conducted their latest hand washing outreach on May 10.

Mensah Gyapong and Aggie Obeng prepared their lesson under the generous shade of a mango tree. The headmaster summoned the children out of their classrooms, and dozens marched towards the shade in an instance of surreal order and calm. With a little murmuring, they circled GHEI staff.

The lesson was straightforward: how you must wash before and after meals, after using the toilet, and simply running your hands underwater is not enough, you have to scrub with soap...fundamentals that many of us take for granted. This was, however, a review for many. When prompted, the group immediately launched into a boisterous recital of 'The Hand Washing Song' in Twi. “…And now in English?” Giggles rippled through the mob, but one brave young man strode to the center of the group, and performed well in front of his teachers and the whole school. ("Soap and water/soap and water/wash your hands/ rub them well together...")

Now the hand washing exercise begins, and the pretense of order crumbles a little, with students jockeying for a chance at impressing with their proper hand washing skills. Just as it looked like chaos loomed, the stern headmaster stood in the eye of the storm and calmed them all. Students lined up again, this time in lines of their respective levels and ages. With Aggie and Mensah supervising, dozens of hands were wet, great bubbles of lather built, and clean hands were rinsed and dried.

Afterward, the students gathered again in the shade for a presentation. The two hand washing monitors of the school were lauded and presented with two bars of soap. Proper hand washing is important, and these two boys promised to continue to be an example.

While the entire event swung from rigid order to joyous quasi-anarchy, the effectiveness of the message was intact. Walking among the playing students on lunch break after the demonstration, many students approached me, palms raised, saying “Look at my hands! They are clean!”

-Chad McCordic, GHEI Communications

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Advocacy Update: to date 4 children have recieved life-saving heart surgery

Abigail Adomoako: 14 years, currently attends Anglican Primary in Humjibre

Mother, Agnes Obeng: “When she was a baby, I had taken her to GBC Hospital [private hospital about 20 minutes from Humjibre] and they had referred her for surgery. When she was 3 years, I took her to Korle Bu Hospital in Accra for her first heart surgery, but afterwards, I saw that she was still very weak. She became tired after walking just a few yards. At times, she would be sick for days and her body would shake; her breathing was hard and fast. I had been trying for years to raise the money for her second surgery, but $8,000 was too much for me to raise. That’s when GHEI helped me find the Boston Children’s group, [a team of pediatric surgeons who come to Ghana yearly to provide training and free surgery] and they helped me get Abigail’s surgery for free. Before the second surgery, she was sick all the time. But now, she can do anything—running, playing, going to school, fetching water. She never complains about feeling tired or sick.”

Lily Ofori-Amanfo: 18 years, currently attends Senior High School in Kumasi

“Before the surgery, I was very weak. At that time I was attending primary school at Bekwai, but I had to drop out and come back to Humjibre because I was too sick to attend school away from home. My father had taken me to Korle Bu Hospital in Accra and they said I needed surgery, but my father did not have money to pay. My father approached GHEI for help, and GHEI connected him to a sponsor who helped fund the surgery in November 2006. Since then, I don’t struggle to breathe like I did before, and I can do anything my friends can do. Thanks to the surgery, I am now attending a Senior High Boarding School at Kumasi. Currently, I am in my third year, and I am majoring in Business.”



Sabina: 10 years, currently attends DC Primary School in Humjibre

GHEI Program Director, Clement Donkor: “Her parents heard about Abigail’s story and approached me for help after they had taken her to Korle Bu and confirmed surgery was needed. For 2 years, they had been trying to raise the money for surgery to no avail. I connected them with Boston Children’s Team, a team of pediatric surgeons who come to Ghana yearly to provide training and free surgery, and she was able to get the surgery in October 2009. Health-wise she has improved more than any other surgery recipient I have worked with, and her improvement has been very rapid. She is very active now and she has gained weight. I always see her playing with her peers, when I walk home from work.”


Portia Adjei Nipa: 7 years, currently attends Primary School in Dansokrom

GHEI Program Director, Clement Donkor: “For years she suffered bouts of lethargy and difficulty breathing before she was hospitalized in 2008 at Korle-Bu Hospital in Ghana’s capital, Accra, where she received her first surgery. A follow-up surgery was scheduled, and her father tried in vain to fund-raise this money while Portia’s health rapidly declined. She was too weak to walk, talk, or attend school. In October 2010, we were able to connect her with the Boston Children’s Hospital team. Since then, Portia has shown marked improvement: before the surgery, you could never get this child to smile no matter what you did; now, she smiles all the time.”


For more information on Portia’s story, see our earlier post 6-Year Old Receives Life-Saving Heart Surgery.

For more information on GHEI's advocacy efforts, click here

--Natalie Rich, GHEI Communications Director

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Advocacy Spotlight: Beatrice Tetteh, M.D., Visits Ghana

Beatrice Tetteh, M.D, is currently in the last few months of her Pediatric Residency Training at Harbor-U.C.L.A. Medical Center in Torrence, California. She recently traveled to Ghana for a month as part of an elective rotation that was a partnership between the UCLA Department of Pediatrics and the Ghana Health and Education Initiative (GHEI). 

Patients at Bekwai Health Center

Describe where you were in Ghana.

I was in the Sefwi Bekwai region of Southwestern Ghana. Specifically, I lived in the village of Humjibre, but did work throughout the Sefwi Bekwai district. Districts in Ghana are synonymous with the County system used in the United States. Living in the village was obviously very different from Southern California. Cocoa farming is the main source of work for the area’s inhabitants, but people are very entrepreneurial, with multiple roadside shops and other businesses [in the village].

The GHEI grounds in Humjibre are located at a cross point between an elementary school and high school. So every morning I could hear school children in the yard playing before the start of classes and reciting lesson plans during the school day. People worked hard during the day, but you still saw people out on the street or at the local drink spots in the evening.

What was the goal of your rotation in Ghana?

One of the objectives was to gain an understanding of the Ghana Health System and to be able to compare/contrast with medical management in the States. It was also to work toward the advocacy side of health care by performing the newborn resuscitation courses and further investigating the congenital heart disease referral process.

Trainees at Bekwai Health Center

One of my other roles was teaching midwives and nurses present at deliveries newborn resuscitation management. Helping Babies Breathe is a curriculum generated from a partnership between the AAP and the World Health Organization. In order to address the Millenium Goal of decreasing infant mortality rates, this curriculum was made specifically for areas with limited resources. I trained midwives, nurses, and other staff present at newborn deliveries in clinics and at the District hospital. Topics covered included recognizing signs of respiratory distress, standard newborn management, and bag mask ventilation. Each participant had hands-on practice with performing bag-mask ventilation.

Clinic at Chirano

Where did the training take place? How many attended?

They were held at Bibiani District Hospital, where we had two training sessions, and both sessions had about 12 attendees. 

We also held one at Chirano Health Center, where we hosted one training course, with about 10 attendees, and we used the same curriculum that we presented at Bibiani. 

We also held a refresher course at Bekwai Health Centre for those that had participated in the training the year prior and those that had not received the training previously.

During your visit, what children’s health issues were being tackled?

Malaria was by far the most common condition that was diagnosed or suspected in the clinic and health center during my clinical work. Often times this was diagnosed according to the patient’s history or by a rapid screening test, much like what we use for RSV/Influenza.

Other health issues included inguinal hernias, tachypnea and poor oral intake. When treating patients we also had to be aware that there were health alternatives that the parents may attempt to utilize instead. For example, we diagnosed an inguinal hernia in an 8-month-old male and informed his mother that he would require at minimum a surgical consult in case it became worst in the future. She stated that she was planning on going to an herbalist to see if he would have any medicine to make the hernia go away. Allopathic medical management is often times in competition with other alternative medical practices and caregivers.

Midwife at Humjibre clinic

What types of interventions did you witness or participate in?

I had the opportunity to observe a delivery at the clinic in Humjibre. The mid-wife performed the delivery, went to clean up, then proceeded to see the patients that were waiting to be seen. Physicians are only found in hospitals and the local clinics/health centers are staffed by midwives/medical assistants, respectively. My main clinical role was seeing patients at the Bekwai Health Center with the medical assistant.

What was the biggest challenge of your work here?

The language barrier! While seeing patients at the health center, I had an interpreter. When I was out an about in the city, I used some of the Twi phrases that I picked up or was able to speak English when that was an option.

GHEI is an NGO founded by a past UCLA Pediatrics resident with the objective of helping the people of Ghana build a sustainable future through community-based health and education projects. Visit http://www.ghei.org for more information and volunteer opportunities. 

Photos courtesy of Beatrice Tetteh, M.D.

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A New Computer For The Library!

After we posted Kesse’s heartfelt request for a computer for the Humjibre library, many of you responded enthusiastically by spreading the word or by donating on our Causes page.

A few months have passed since then, and with your help, we have reached our goal! A new computer is on its way to the Humjibre Community Library!

When Kesse was shown his letter and picture on the internet, it was difficult for him to grasp the idea: “How can people read my letter without sending copies of it to everyone?” It’s easy to understand his confusion when you realize that his only experience with a computer up till then was what he has read in books.

Kesse has been checking in on the fundraising progress since he was first shown the blog entry. Although the internet remains somewhat confusing to Kesse, it is less so now. He understands that his words have been read around the world, and that people like you have responded. He knows that his words have made a difference for his fellow classmates and the community of Humjibre.

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GHEI Launches World Malaria Day!

A record number of attendees turned out for GHEI's 2-day World Malaria Day event, for what some community members called "one of the best GHEI outreaches ever!" An estimated 500 people crowded the Humjibre Community Centre on the evening of April 25th for a lively, interactive event facilitated by Aggie Obeng and Mensah Gyapong, GHEI's newly promoted Health Program Assistants.

Following a review of GHEI's picture-based malaria flip book, Aggie and Mensah invited the crowd to participate in bednet hanging demonstrations, like the one pictured on the left. Here, a mother demonstrates how she would put her children to bed under a bednet, including tucking the net into the mattress to prevent mosquitoes from entering. Aggie then posed some discussion questions, like "Who should sleep under a bednet?" and "What should you do if your bednet is torn?" and audience members eagerly rushed the microphone to give their responses.

After the discussion, the ever-popular GHEI-produced film United Against Malaria, directed and produced by film-maker Laconia Koerner and featuring the Humjibre CHWs, was shown. The health team then debuted a documentary short about GHEI produced by Fernando Sapelli and the People of Change project. Cheers and giggles rippled through the crowd as they viewed shots of the familiar people and places of their hometown. Community leaders beamed with admiration at seeing themselves on the big screen.

On the heels of this success, the health team repeated the outreach at the nearby village of Soroano 2 days later, where a record 300 Soroano community members attended the event (roughly 1/3 of the community). By the time the film started, it was standing room only, with people crowding the windows and doorways of the venue to try and get a peak. "I think everyone really responded to the participatory aspects of this outreach," commented GHEI Education Program Coordinator, Jen Artibello, "having audience members demonstrate proper bednet usage in front of their peers really seemed to engage people." Other attendees credited the film showing: "Ghanaians love films! Anything that includes a film-showing is sure to be a success!"

--Natalie Rich, GHEI Communications Director

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Proven Malaria Program Expands to New Village

Kojina is a small village of 360 people located about 2 km from the village of Humjibre, where GHEI is based. Before expanding our malaria program to Kojina, we first met with the village chief, Nana Adomakwahene, to present the idea and receive his permission. He understands the problems associated with malaria, so he welcomed the idea that we would provide bednets and help the people of Kojina protect themselves from mosquito bites. We then selected and trained two residents of Kojina to serve as Community Health Workers (CHWs) to distribute the nets and to educate the people of Kojina about bednets and malaria prevention.

In January, a baseline survey of Kojina’s 43 households was conducted by two health program staff and four Community Health Workers certified in Data Collection. The survey included questions about the number of bednets (if any) a household owned, the condition of these nets, knowledge of proper bednet usage, and questions to determine the number of sleeping sites in each household.

Some statistics on the population of Kojina from our data collection (before the distribution):

• 19% of children under age five sleep under a bednet

• 15% of the population sleep under a bednet

• 0 % of pregnant women sleep under a bednet

• 40% of households have at least one net in any condition

• 48% of children age 0-4 years had a fever in the last two weeks

After we completed the baseline survey in Kojina, we held a Malaria Outreach Event at the end of January to teach the community about malaria and bednet usage and inform them of our upcoming distribution. Nearly one third of the community—around 50 children and 60 adults—attended the outreach, which featured a showing of the GHEI-produced film United Against Malaria, a short drama encouraging people to seek medical help for malaria symptoms and to sleep under bednets.  The film was directed and produced by film-maker Laconia Koerner in February 2010 and features GHEI's team of Community Health Workers.

Thanks to a generous bednet donation from our partner Against Malaria Foundation, GHEI CHWs from Humjibre and Kojina hung 158 bednets in 44 homes in Kojina. Some days we started distribution in the early morning, and some days we went in the late afternoon to have a better chance of meeting people in their homes. We worked in teams of 3-4 CHWs going door-to-door to ensure that every household received bednets and flipchart education. At each house, two CHWs sought permission to enter the sleeping areas to begin hanging the bednets using the method most appropriate for that room and the number of sleeping sites. A third CHW met with the residents of the household and gave the flipchart education on bednet usage and care. After the bednets were hung and everyone viewed the flipchart, the CHWs demonstrated how to rehang and properly use the bednet.

With the distribution now complete, the two Kojina CHWs will begin follow up visits with every household in Kojina. During these visits, CHWs will help rehang bednets, mend bednets, and provide ongoing malaria education. Through continued education and assistance, we aim for universal usage in all the communities we support through bednet distribution and follow up visits.

For more information on GHEI’s Malaria Prevention Program, click here.

Stay tuned for slideshows and videos from the Kojina Bednet Distribution!

--GHEI Health Program Coordinator, Carly Edwards

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Behind the Scenes with GHEI Documentary Film-maker

“Filming in Humbjire certainly stands out as one of the most rewarding experiences,” film-maker Fernando Sapelli recounts, “It was fulfilling to obtain people’s opinions about GHEI, further confirming the efficiency of its work.”

Born and raised in Brazil, Sapelli completed his degree in Film & Media Studies and Dramatic Arts at the University of California, Santa Barbara. Since then, he has worked in production companies like Leonardo diCaprio's Appian Way and Sony Pictures Television. In 2010, he embarked on the 7-month “People of Change” project which took him to 16 countries recording the work of select NGOs in 10-15 minute documentary-style films. Sapelli heard about GHEI while filming in South Africa and immediately agreed to include GHEI in the project: “I tried to focus on different types of NGOs. GHEI had projects assisting both education and health deficiencies, and [it] had a very specific manner of conducting [its] work. Few are the organizations who try to employ and train locally, as opposed to having an ongoing dependency on foreign expertise.” Sapelli filmed the GHEI documentary in May 2010, before returning to the US to edit and produce the film.

Sapelli is currently working with Oscar-nominated producer Hank Levine on a new documentary, entitled "Refugee Diaries," about people who are displaced because of their political or religious beliefs or their sexual orientation.

Reflecting on his time with GHEI, Sapelli recounts, “The people are what made it original. From GHEI's staff to their families, everyone was warmhearted and welcoming. We shared smiles, stories, moments. And those are the memories I've carried with me.”

Click here to watch the GHEI documentary.

For more information on Fernando Sapelli and his “People of Change” project, visit his website http://fernandosapelli.com/

--Natalie Rich, GHEI Communications Director

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Student Learning Tour visits Cape Coast

"What do you call this water?" Sophia, a junior high student asked, pointing at the waves pounding the castle walls below. Like most of GHEI's students in the Youth Education Program, Sophia had never seen the ocean. On the balcony of Cape Coast Castle overlooking the Gulf of Guinea, 43 junior high students and 8 teachers stood wide-eyed and breathless at the site. It was the culmination of the day's excursion, which featured many firsts for both staff and students.

Every year, GHEI hosts a free excursion to expose students to the scenic and historical sites Ghana has to offer, sites they otherwise would never experience. This was the first year GHEI took students to Cape Coast, where they were treated to a canopy walk through the rainforest at Kakum National Park, a computer class at the prestigious Cape Coast University, a guided tour of the infamous Cape Coast slave castle, and their very first dip in the ocean's saltwater waves.

Check out the slideshow (Photos courtesy of Education Program Coordinator, Jennifer Artibello) for highlights of this memorable day. For more information on GHEI's Youth Education Program, click here.






--Natalie Rich, Communications Director

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GHEI Documentary

Documentary film artist, Fernando Sapelli, visited Humjibre in the spring of 2010 in order to capture the essence of GHEI on film. Check out the final cut, featuring all your favorite folks from Humjibre--Clement, Happy, Sister Comfort, Aggie and MORE!

People of Change - Ghana Health and Education Initiative (GHEI) from Fernando Sapelli on Vimeo.

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