Ceri Jones - Public Health in Ghana
Africa to me epitomises public health medicine; with its ongoing vaccination, child welfare, HIV/AIDs awareness and tropical disease programmes. It covers just about every discipline public health has to offer.
So, I ask myself where this urge for wanderlust to the developing world stems from. I suppose I had always had a passion to visit Africa and felt that with no direct experience within public health practice, it would be in my interest to get some. So, January 2015, I flew to the Ghanaian capital, Accra with Projects Abroad. My placement was at Dodowa district hospital in the Greater Accra region, approximately 90 minutes from the capital.
My decision to go was based on a desire for adventure combined with sheer bloody-mindedness resulting from pessimistic colleagues who were somewhat geographically challenged with regard to the Ebola epidemic - colleagues who thought that West Africa was a country in its own right. The support of my family, particularly my wife, helped me dismiss all uncertainty and hesitancy of going it alone.
I arrived in Accra to an ambient temperature of 38 degrees and midway through the dry season. The work primarily undertaken would be concentrated on two main areas: child welfare and infectious disease.
Volunteering on the Public Health placement
Public Health within Ghana tends to have close collaborations with medical institutions. With population health being the main anxiety for the Ghana Health Service who spreads its message to the community level through the medium of public service announcements and active outreach programmes. As a centralised governing body it oversees healthcare between primary i.e. rural clinics and tertiary care i.e. local and regional hospitals, allowing it to have direct impact on individual care through a population health lens.
During my first week, I attended many outreach projects and Ghana Community-based Health Planning and Services (CHPS) initiatives, programmes that were to be eventually upgraded to health centres. Here, I was able to get some hands-on experience, vaccinating children for measles, yellow fever, polio, rotavirus and pneumococcal virus.
Secondly, weighing and registering new births and patients at outreaches and health centres, attending schools and orphanages with community nurses to provide a one stop shop examining for cuts, grazes and ringworm and also identifying environmental health issues.
The most harrowing story I encountered was at the Potter’s village orphanage where a small girl who, when newly born, had been found in a dustbin. The girl is now thriving and developing well at this institution.
Maintaining the necessary specialist skills to develop healthcare staff is centrally coordinated by the Ghana Health Service. This enables a system of nested medical provider institutions to preserve close links and good communication channels. In Shai-Osudoku district, the health service organises refresher courses and workshops to enable staff to maintain their skills. This allows staff at CHPS compounds in Dangme West district to meet with their colleagues at the district hospital.
In the second week, I was able to organise work experience at the Dodowa Health Research Centre. This is one of three research centres within Ghana that collects data from local healthcare institutions within the region that encompass both Shai-Osuduku and Ningo-Pram Pram districts. The data collected includes maternal mortality statistics and rates of infection which are used to formulate strategies and policy at local and national level.
Volunteering in Ghana
During my time at the research centre, I had the opportunity to collect surveillance data out in the field. This involved leaving at 6am to liaise with field officers at different points within the region. Data obtained was then uploaded to a central database for evaluation later.
The district public health service were awe inspiring in their ability to maximise the limited resources available. I feel the developed world could gain considerably from exchanging knowledge with such nations. However, a disadvantage to the current system is Ghana Health Service’s centralised top down approach to controlling all finances, equipment and staff.
All district hospitals and health centres are reliant upon the governing healthcare body for the delivery of all resources. With no flexibility to pursue support from other organisations. Each district is comprised of approximately 100,000 people and supported by roughly 12 health facilities. With such a high patient population to support, the Ghana health service does not have the capacity to provide essential resources to all districts and as a result gaps remain within this strategy.
A lot of public health issues could be better managed in Ghana if communication channels were improved. Relaying the needs of districts to the governing organisation is paramount if the service is to evolve. For example, while I was at the hospital there was a powercut for one week (inherent problem within the country) and the hospital retains a limited number of back up generators. Senior staff frantically negotiated with local power companies and governmental agencies to remedy the situation. However, with better communication and better planning between the Ghana Health Service and the district healthcare providers, strategies could be identified to alleviate the disruption caused by these events and maintain better healthcare for the country.
I hope to return to Ghana in the next few years.