By Rebecca Czekalski
Humanist Service Corps Volunteer
In a piece a while back, I had talked at length about a health screening and medical records project being undertaken in Kukuo by the Humanist Service Corps. Six young people, who had been born and raised in Kukuo, were selected by the local councilman for their bilingual abilities and interest in the project. I trained these six young people three days a week for a month and wrote protocols so that they would be able to record demographic information and health histories, and take and evaluate vital signs. They were also trained to screen for diabetes risk and test for diabetes if a person had a moderate or higher risk. They were trained to evaluate for signs of malaria and perform a rapid blood screen if a person exhibited three or more symptoms of malaria, to evaluate for signs of tuberculosis, and to check all children age five and younger to make sure that they had received all of their vaccinations. This screening project began in the beginning of February 2016 and finished in the middle of May 2016.
It was an intense few months.
Now that the dust from this project has settled and a thorough records review has been done, HSC is ready to release the data from this project. The project has been wildly successful, to say the very least. A lot of lives have been improved, with a project led and performed by members of the community with only the behind-the-scenes assistance of HSC volunteers. It is important that HSC volunteers stay out of the public eye, because one of our guiding principles is to be careful not to feed into the narrative of foreigners coming to “save” the local people of Ghana. Ghanaians don’t need saving, especially not at the hands of someone who has only interacted with the culture for less than a year. Also, particularly with healthcare, it is important not to undermine the work being done by local agencies and local people, because that can cause a lack of trust between the local people and their healthcare system. It is important to not feed into narratives of colonialism and “white saviorism” that are often prevalent in international service.
When we started the project we couldn’t have known the depth and width this project would reach. Through this project we have not only improved the health and healthcare access for the women accused of witchcraft living in Kukuo, but have discovered non-medical issues that we were able to address and made discoveries that will impact the wider Ghana population and policy.
Accomplishments of the Kukuo Health Screening Project
Malaria: Every person in Kukuo was screened for symptoms of malaria, so 1,015 people in all. Three refused to participate in the screenings. We did not ask them why, because we wanted to respect their autonomy and not pressure them. We wanted our informed consent that was obtained before every screening to actually be consensual. 443 people had three or more symptoms of malaria and were given a rapid blood test to check for malaria. Of these 443 people, 91 tested positive for malaria. These were all referred to the Kukuo Community Health and Family Planning Services (CHFPS) clinic at the edge of the village and received a follow-up malaria symptom evaluation. Of these 91 who initially tested positive for malaria, 22 were still positive when the Kukuo Health Screening Volunteers did follow-up.
In 17 of these cases, the people in question had not taken any medications for their malaria. Unfortunately, some people within the Kukuo community do not wish to go to the Kukuo Clinic because of personality conflicts with the staff. In a relationship culture, not having a respectful relationship can cost lives. Others did not take medication because they didn’t feel that bad, so didn’t think they needed any medication. Others avoided medication because of the side effects, particularly nausea and dizziness. All of these people who were found to be malaria positive a second time were given ACT, which is the standard medication for malaria in this region, along with instructions for how to take it by the volunteers doing the follow-up. You can never go over instructions for medications too many times.
In five of these cases, the people had taken all of their medications for malaria properly, but they had a strain of malaria that was resistant to the standard medications that are stocked at the Kukuo CHFPS clinic. The Kukuo CHFPS clinic and the Ghana Health Services for Nanumba South were notified. A second medication is now being stocked at the Kukuo CHFPS clinic to combat these cases. Without this project and its follow-up, this resistant strain of malaria in Kukuo most likely would not have been caught this early.
A resistant strain of malaria is a type of plasmodium that has mutated to the point of being able to survive the typical medications that should kill it. It is basically a malarial superbug, but on a less powerful scale. This particular type of resistance in Kukuo does respond to other common medications. Having this second medication in stock at the clinic means less time spent suffering with malaria for those with resistant malaria. It can also save lives in the case of the elderly, the very young, and the malnourished.
The Kukuo CHFPS clinic has been given a list of the 22 cases of malaria that will need further follow-up, along with a box of 50 malaria rapid tests, because the Nanumba South supply of these tests has been greatly strained by this malaria season.
In total, 52 people were supplied with ACT over the course of this program facilitated by HSC, due to inability to pay. This medication cost was covered by a private grant. HSC also facilitated a 850 Ghana Cedi ($212 USD) grant to cover malaria care for those who cannot pay throughout this malaria season at the Kukuo CHFPS Clinic.
Tuberculosis: 1015 people in Kukuo were screened for signs of tuberculosis. Of those, 57 had three or more symptoms of tuberculosis and were referred to the Kukuo CHFPS clinic. 35 had three or more symptoms including a cough, which holds a much stronger likelihood of them having tuberculosis.
Because tuberculosis requires sterile sputum collection and laboratory testing, our non-medical volunteers were not qualified to perform this task. The nurses from the Kukuo CHFPS clinic have collected sputum samples from the 35 people with three or more symptoms including cough, and we are currently awaiting the results of those samples.
Vaccinations of children under the age of five: Every child age five and younger had their medical records checked to ensure they had received all of the appropriate vaccinations.
Of the 178 children age five and younger in Kukuo, only 29 did not have every single vaccination signed off in their medical records. It should be noted that this does not necessarily mean the child was not vaccinated. It is more than likely that some of these 29 “missing” vaccinations are merely paperwork errors because everything is handwritten and there are only two public health nurses for all 178 children under the age of five.
This upcoming Saturday, the Kukuo CHFPS staff and I will be sitting down with baby books and clinic records and reconciling the records of all 29 of these children, as well as ensuring that all of the clinic records are fully updated.
If any children are then found to have missed vaccinations, their parents will be notified and these children will be vaccinated during the August vaccination day. Because their is no reliable refrigeration in Kukuo, vaccines are only given one day per month. This way, a single 60 dose vial can be opened and used in a single day, because the vials cannot be stored once they are opened. This is a prime example of Kukuo nurses putting in place systems that can work in their specific context. This method also allows for easier tracking of which babies have been vaccinated and when, since there is only one possible day per month on which the baby could have received a vaccination.
Insurance: The vast majority of people in Kukuo either have no health insurance or have expired health insurance. Only 109 people in Kukuo currently have active health insurance, leaving 906 with no insurance or expired insurance.
Councilman Tanimu, the Kukuo representative to the Nanumba South legislature, has been able to have funds appropriated to cover the cost of health insurance for the year for all victims of witchcraft allegations living in Kukuo. The Wulensi Insurance people will come out to Kukuo to enroll all victims of witchcraft accusations and as many babies as there are time to enroll. Additionally, I have been able to connect with the insurance people in Bimbilla, where Songtaba and HSC are located near Kukuo. An insurance drive is planned for the entire village after Wulensi has finished enrolling those in vulnerable populations. Here is an example of how HSC and local politicians have been able to work together on similar goals using local resources. It also showcases HSC’s desire to follow the lead and desires of the communities we serve. We uncovered a problem, but were more than happy to help fix the problem at the request of the community.
Diabetes: All adults in Kukuo were screened for their risk of developing diabetes within the next ten years. Those at moderate or higher risk had their blood sugar checked.
Of the 507 adults in Kukuo, 10 were at moderate or higher risk of developing diabetes and had their blood sugar checked.
Of these 10, two had high blood sugar, five had blood sugars within normal limits, and three had slightly low blood sugar at the time of screening.
These 10 people were referred to the Kukuo CHFPS Clinic for further monitoring and follow-up. The two people with high blood sugar have had dietary counseling and are being closely monitored by the Kukuo Clinic. If their blood sugar doesn’t go down within the month, they will be treated at Bimbilla hospital, which has a dedicated diabetes clinic.
Hypertension: Adults had their blood pressure taken. Any blood pressures over 140/90 were referred to the Kukuo CHFPS clinic for evaluation and dietary teaching.
Of the 507 adults in Kukuo, 69 had hypertension. Of these cases, only three have well-controlled hypertension on their current medications.
As hypertension can be extremely volatile, it cannot be treated at the Kukuo CHFPS clinic. People with hypertension must go to Bimbilla to be evaluated and started on medication. This is a problem that must be solved after the insurance has been obtained due to the cost of being treated at Bimbilla hospital.
Nutritional deficits: Many people in Kukuo have nutritional deficits as defined by the World Health Organization. They have a Body Mass Index (BMI) of less than 18 if they are an adult, or a Middle Upper Arm Circumference (MUAC) of less than 12 for children under the age of 7.
287 people in Kukuo, or 28.2% of the population, have nutritional deficits. 28 of these are children under the age of five. All of these were referred to the Kukuo CHFPS Clinic for monitoring and intervention as appropriate.
A list of all people in Kukuo with nutritional deficits was given to the Kukuo CHFPS nurses and to the Nutrition Officer in Wulensi. As were a list of all children age five and younger with their height, weight, height-for-weight, and MUAC as compared to all other children around the world from WHO field charts. A chart explaining normal limits of BMI was created and given to the Kukuo CHFPS nurses and the Nutrition Officer per their request, as they are unfamiliar with using BMI in those under the age of 18.
Other issues: Several other issues were uncovered over the course of the Kukuo Health Screening Project and are being dealt with at the community level.
Three people are non-compliant with their current medication regimen. They have been referred to the Kukuo CHFPS Clinic and the clinic has been given a list of the people and details.
Two underage marriages were discovered and referred to the community leaders. One of the reasons this number is so low is because Kukuo banned underage marriage in the community more than 10 years ago and has strictly enforced this ban..
Four girls and three boys were discovered to be working instead of being in school. These were referred to the community leaders and the local Basic Complementary Education program has been notified of their situations.
Two people were found to be in need of wheelchairs.
Memunatu, whose story has been discussed on this site before, broke her hip four years ago and has been unable to walk or bear weight since then. My family and friends purchased a wheelchair for her as a birthday gift to me. She has had her wheelchair for about a month now and is very happy with it. The children of the village regularly push her around in it, and she has been able to reconnect with her friends in the village.
Just this morning, I was asked to visit at the home of Sana by her father. Sana is 23 years old, and has been unable to walk since she was about one year old. She was developing normally for her age, was struck by a sudden illness, and has been unable to use her legs since her recovery from this illness. She also has severe developmental delays as a result of this illness. Her family had been connected with an NGO that gave them a wheelchair for Sana about 15 years ago. They had a deal with the NGO that as long as the family paid 25 cedi per month, the NGO would replace Sana’s wheelchair every five years as she grew. The family worked hard to make sure they had that 25 cedi per month, and paid it on time for many years. Unfortunately, they were having a family friend take the money to Bimbilla and wire it for them each month. They did not know that this man was actually stealing their money instead of sending it until it was time for Sana to get a new wheelchair. When Sana’s father contacted the NGO to ask about Sana’s new wheelchair, he was informed that they had never received any money from the family and that the NGO would no longer work with them. I am currently applying to several other NGOs that give wheelchairs on Sana’s behalf and am working to get private donors lined up in case buying Sana a wheelchair outright is the best way to go.
Census: The Nanumba South legislature has wanted to do a census in each village in the area for the last five years. However, no census was ever performed due to staffing and budgetary constraints. Kukuo, a camp for alleged witches, is now the first and only community to have a census in Nanumba South. Population statistics were done by hand, and now all of this information is printed and is being kept in Kukuo and Wulensi.
Birth and death records: Birth and Death records were implemented and are now in use at the Kukuo CHFPS Clinic.
The news of this program’s success has spread far and wide. The Ghana Health Service for Nanumba South has decided to implement a pilot program in three villages next year using this program as a template. I was asked to teach 10 public health nurses for Ghana Health Service about this program and how it runs. This teaching was completed last week. Their program is called the Community-Based Health Screening Program by Non-Medical Personnel. It is being run by a grant from the Ghana government intended for programs that will decrease the workload of nurses in rural areas.
Nanumba North has also contacted me and asked to be trained regarding our program. They have no funding at present, and it is too late to apply for the same grant as Nanumba South. However, I am training 12 public health nurses for Nanumba North this week, so that if they are able to get funding, they also can launch this program.
The Nanumba South legislature has taken a template with instructions from HSC’s project so that they can train local people to take a census in each village and have them all have the same format. Our template will be used for the entire region.
All of these are excellent results that came about because the Humanist Service Corps asked the Kukuo community what was needed, listened to their recommendations and needs, designed a program that the entire community approved of, and used local resources and trained local people to carry out the program.
This project has far exceeded even my own expectations. It showcases well the values and priorities of the Humanist Service Corps. This project was suggested by locals, developed with locals, and run by local faces, with HSC personnel entirely in the background. This project transferred skills and knowledge to the community to avoid creating a dependence on foreign aid. This project was largely successful in tangibly increasing the quality of life of local people using local resources. Lastly, this project will be sustainable over the long term because of the relationships that have been built and the resources that have been connected to those within the community, including at the local government level. This project is a good showcase of the type of international service the Humanist Service Corps can accomplish. Even though I am leaving Ghana soon, this project has been designed to live well beyond my departure.
Rebecca Czekalski has taught in the science department of a dual language international high school in South Korea for the last five years. During that time, she has co-authored the school’s AP Biology and AP Chemistry curricula, collaborated on science- and English-themed camps for Korean elementary schools, and launched an annual science fair for her students. Before moving to Korea, Rebecca was a registered nurse for eight years, specializing in cardiac nursing, and a travel nurse for two years. Rebecca’s interests in other cultures and serving people have made her time in Korea rewarding both personally and professionally, and she looks forward to continuing her journey in Ghana. Rebecca has been a secular humanist for three years.