The year is ending with a light day of work at the clinic. New Years is primarily a religious occasion in Ghana, with Catholic mass both this evening and in the morning. People seem to accept our explanation that as mere Presbyterians we are not accustomed to attending church quite that often and will, thus, be staying “in the house” (staying home).
A bit of information about health insurance in Ghana
I happened to be in Ghana as a National Health Insurance Plan was instituted in March 2006. It is now functioning quite well for about 1/3 of the farmers in this area, an adult can get insurance for themselves and their children for the incredibly low cost of $10/year. The other 2/3 cannot afford the insurance even at that cost. It does take 3-6 months to become insured, one of the few negative things one could say about the insurance. The plan covers valuation and treatment, including drugs, for most of the common health problems seen at the Kongo Clinic and some minor surgeries, but not HIV/AIDS treatment or major surgeries. Things that are fairly routine in the US, for example cataract surgery and heart surgery, are not covered. It seems to me the clinic is seeing fewer urgent problems, I speculate that is because insured patients seek care earlier instead of waiting to see how bad the illness will get in an effort to save money. I don’t know the details, but the central government must be substantially subsidizing the health coverage. Though health workers are paid a very low wage (nurses with three years of nurses training start out making $300/month), individual payments for coverage could not even come close to covering the government’s costs to provide health services and drugs to the insured. Looking at the very poor country of Ghana and the government’s efforts to provide affordable health insurance makes me wonder why the richest country in the world (as in the USA) cannot do more to make health insurance affordable and accessible for its citizens.
If you saw our website from 2 years ago, you read of Kologbil, an 18 year old Kongo farm boy/shepherd boy that David and I have been helping out by paying school fees. He has no relatives to help him with school fees but a strong desire to go to school. We are so happy for him in regards to the progress he has made in school. He is currently enrolled in Primary 6 (6th grade), and now converses with us fluently in English, where as communication without an interpreter was nearly impossible during our last visit. Students do not begin learning English until Primary 3 and for most it takes four or five years before they are able to hesitantly converse and read in English. I am astounded at Kolobil’s progress, especially in light of the fact that he is learning English in a classroom of 100 students! It is my theory that every bit of basic academic knowledge and familiarity with English is of great help in being capable of taking take care of oneself as an adult in West Africa. Due to the large amount of heavy work he must do on the farm, Kologbil now needs surgery for an inguinal hernia. We have started the process of getting him on the health insurance plan so that hernia repair surgery can happen this spring. I am so glad we have been able to help this determined, quiet, intelligent boy. 
We have been regularly working on obtaining resources for farmers. Two days ago we attended a large meeting of the dry season farmers from the area, I would guess 100 farmers attended from a 7 square mile area that includes 12 or so villages. David and I have a meeting on Thursday with a non-governmental organization (NGO) called Technoserve that funds farming projects. It will be great when we get past the information gathering stage and are actually able to spring into action on the farming front.
As for now, I will be having a Fra Fra lesson with one of the unemployed local youth at a rate of $2/hour, a very generous rate of pay for these parts. Progress is slow but steady on the language front. Fra Fra is not a written language, and I swear my teacher changes some of the pronunciations and even the actual words weekly!
January 8, 2008
We have returned from a refreshing three day trip to Ouagadougou, the capital of Burkina Faso. We ate, shopped, took hot showers, sent DJ back to the US in time for Monday classes at PSU, and dodged persistent purveyors of belts, phone cards, foreign magazines, and craft items. It is with a mixture of sympathy and annoyance that we began to dodge people on the street who are merely trying to feed themselves. These are not violent or dishonest people, but people desperate to make a little money for food and shelter. Unfortunately, there seem to be a dozen mildly desperate people selling items for each tourist on the street. And, a tourist has to say “No” repeatedly before they cease in their efforts.
The eighty degree evenings evenings in West Africa at this time of year are perfect for dining on the broad sidewalk of a bistro. During our dinners in Ouaga, a group of street sellers would quietly stand 10-20 feet away to keep an eye on us for an hour or more as we ate, but not interfering with our dinner. During dinner, David, DJ, and I would make a plan for the most rapid and least obstructed path back to the hotel or the internet. Our greatest success occurred when we all headed for the same spot at the edge of restaurant seating, and then abruptly headed in 3 different directions before crossing the street. The moment of confusion was enough to allow our unhampered escape.
Back in Kongo, we cook at home on a 2 burner propane stove, very similar to a camping stove. We are having guinea fowl and rice for dinner tonight, eating one of the six guinea fowl that have been given to us since arriving. And a papaya for dessert, given to us by an impressive dry season farmer. This particular farmer has water not far below ground level, only 5 feet in some spots. He has a small commercial fish pond, papaya and banana trees; all unusual for this area.
It was wonderful to share our experiences in Ghana with DJ. He was enthusiastic and uncomplaining about everything, even the cold showers and the less than comfortable developing world travel adventures. He did a fantastic job teaching computer classes to the local kids, an opportunity they would not have had if it were not for his presence. His students hated to see him leave as much as we did.
A memorable “DJ moment” for me occurred when we stopped by to say hello during a computer class. We had just purchased a used motorcycle and there was a definite “this is weird” look on DJ’s face as he watched his parents ride off. And of course he offered some sage advice. I believe the exact quote was, “Don’t crash.” As was to be expected, DJ eagerly learned to ride the motorcycle himself in record time and took off on some independent trips to neighboring villages.
Since our return from Ouaga, the weather has been unusually cold for this part of the world, sometimes dipping below 70 degrees at night. The Ghanaians are even wimpier than Portlanders when it comes to “cold” weather. People are too cold leave their house if it is below 75 degrees, having the same effect on daily routines as ½ inch of snow in Portland. Teachers can expect that students will come 2 hours late. The clinic will be deserted. When people arrive they will be wearing multiple layers of clothing and be shaking with the cold, their hands will be icy. As for us white folks from the Northwest, it still seems like shorts weather.
And now for an update in regards to our work in the community. We have now been here nearly four weeks, during which time we have attended numerous meetings and spoken with many struggling people. We have defined four ways in which we might assist Nabdam, the impoverished farming district in which Kongo is located. Some projects relate to immediate needs for survival and some relate to long term economic development. Several projects are appropriate for funding by NGOs or grants:
<!–[if !supportLists]–>1. <!–[endif]–>Recruit volunteers similar to ourselves to work for periods of time in this very welcoming community. We currently spend most of our time providing medical and chiropractic care in the clinic (Lisa) and teaching English in the schools (David).
<!–[if !supportLists]–>2. <!–[endif]–>Work with Nabdam farmers to improve food security. We are cautiously optimistic that the community can work in collaboration with the NGO Technoserve to improve yields. Farming practices promoted and financed by this organization include donkeys or bullocks for tilling, improved seeds, fertilizers, pesticides, storage of crops for the dry season, better poultry farming techniques, and other improvements to animal husbandry. This is the most extensive and financially ambitious of our undertakings and, if successful, will be of the greatest long term benefit. Technoserve is largely funded by USAID, an aid organization of the US government.
<!–[if !supportLists]–>3. <!–[endif]–>Formulation of a committee with representation from each Nabdam village. The purpose of this committee is to mobilize resources for needs and development that have bearing on the entire Nabdam district. David’s brother-in-law, Tom Coleman, has already been asked to look for grants to fund the committee’s first urgent project – school feeding. Severe flooding in the midst of the 2007 growing season resulted in loss of over half of the staple food crops this year. Food will be scarce in homes until the next harvest. The committee hopes that providing millet or rice for students at mid-day will prevent large scale malnutrition whilst maintaining, or even boosting, school attendance. Parents will volunteer to cook and serve the food, each student will be expected to bring firewood for cooking, as well as small amounts of beans to add to the grains. This is a substantial project in that there are 10,000 pre-kindergarten through senior high students in Nabdam schools. The lunch cost is $1/student/week to provide a daily serving of grain. We hope to assist the committee in providing meals for the 10 weeks when food shortages are most severe – mid March, April, and May. Total cost: $100,000. Interestingly, Ghana received far more food aid, such as bags of corn, before the ethanol boom. The US and Canada reportedly now use much of their excess grain production for fuel.
<!–[if !supportLists]–>4. <!–[endif]–>Donating “small, small” (in the local vernacular) for immediate needs relating to food and school fees for families that live in or near Kongo, the village where we live. We do this through the local St Vincent De Paul Society who collects letters from students requesting help and keeps a small storage room with millet and rice. A committee of three evaluates the requests and allocates the resources. Our role is to provide some funds, we are able to donate $600 during our visit, and insure that the committee distributes the resources equitably.
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