Highs and Lows

To sum up my whole experience in Ghana, I thought it would be easiest to list my highs and lows of the trip. The highs majorly outweighed the lows (there were hardly any), so I’ll start with the lows first.

  • I got sick a few times, about 2 ½ to be more exact. I never figured out what this came from, but luckily each instance was short lived and I didn’t have to miss out on any part of the trip. This was my first time ever being sick on any sort of international trip, so I feel like I’ve finally paid my dues.
  • The projects I was assigned to co-lead with Lauren were transition services and vocational skills building. We did our best to prepare for our time in Ghana, but as I’ve explained more in other posts, what we had prepared wasn’t as helpful as we’d hoped. A variety of issued factored into this, but the upside was that we learned so much about the culture, education system, and people that we know what will work better next time.

Now for the highs… there’s too many to list in one post so I stopped with ten, but could go on and on.

  • As part of the Volta group, I was able to see both urban and rural Ghana. Since there were so many differences between the two, I felt that I was able to learn so much more about the culture just by comparing Accra and Hohoe.
  • Our driver, Vincent, was amazing. He kept our time in Hohoe and Accra running smoothly and always looked out for us (he also helped me keep track of my back pack which I somehow always lost in our tro tro). On our last night at the orphanage, Vincent came and sat with our group while we were hanging out with the kids before they went to bed. One of my favorite kids, Luke, had been talking to me about our flight home and was getting sad for us to leave. He wanted to know when I would be back again, and I was having a hard time figuring out how to tell him that I didn’t know. This turned into Luke asking me about age and how big he would be when we came back. Thankfully, Vincent stepped in and steered the conversation towards how old Luke could become. He told him that when he got to 100, he would be walking with three legs, and then picked up a stick and showed him how to walk with a cane. Luke couldn’t believe this, and then picked up the stick and walked around like and old man. It was nice to see how the younger kids looked up to Vincent. This little moment became one of the more memorable parts of the trip for me.
  • Getting to know the children at Eugemot was the core of the trip. We all had planned different projects and also worked with children at the school for several days, but the majority of our time was spent at the orphanage. Almost all of the kids spoke English, so it was easy to get to know all of them. We helped them with handwriting and health education, read books, played soccer, worked on fine motor skills with loom bracelets, and talked with the older kids about their plans for the future. It was impossible not to become attached to the kids and I think we all miss them more than anything else.
  • Our day trips to Mt. Afadjato and Wli Falls added so much to the trip. Mt. Afadjato is the highest mountain in West Africa and by far the steepest mountain I’ve ever climbed. Parts of the trail on the way up were so steep that we were using our arms to climb more than our legs. From the top, you can see Togo in one direction and a sweeping view of Volta in the other, so it was worth the effort. Wli Falls is the tallest waterfall in West Africa. We were able to take about 20 of the Eugemot children with us. Many of them had never been before, so this was a pretty big event for them. The force of the water falling from 70 meters up was so great that we had to turn around and walk backwards as we got closer. Luke loved playing in the water and wanted to come with me when I walked under. He had been identified as sensory seeking on a previous trip, so this might explain why he was the only young kid to make it under the waterfall.
  • On one hand, it was disappointing that my projects didn’t work out as planned. But this opened up many learning opportunities, which will hopefully end up helping groups who go in the future.
  • Speaking of learning opportunities, in Volta, we spent a good amount of time talking with the older Eugemot kids and Mama’s daughter, Yvonne, over dinners. I doubt we would have learned half of what we did if it weren’t for these conversations. Yvonne had been to the United States to work at a summer camp, so she had a lot to offer on the differences between our two countries. We talked about everything from Ghanaian social policies to veterinarians and clothes for pets in the US (it’s starts to seem excessive when you’re in a country that hardly has adequate health care for humans). She summed up the disability culture differences between the US and Ghana perfectly by saying that we both have the same problems, but on different scales.
  • Bright, who I wrote about in a previous post, crushed my plans to not become attached to one kid at the orphanage more than others. He provided our group with endless entertainment. I’ll think of him every time I hear someone say ‘Jesus Christ’ or get my haircut. His nickname, Mr. Sassypants, was well deserved.
  • Through this trip, I realized how much I didn’t know about classmates who I’d been around constantly for an entire year. Traveling helps reveal layers of personality in a way that not many other things can (I mean this in a good way, promise!). Our group meshed well and made the trip that much more enjoyable.
  • Our hotel/nightclub in Volta was a definite memory maker. It will be hard to forget eating my fried egg and rice for our first Volta dinner under nothing but the light of a miniature spinning disco ball with Slumdog Millionaire playing in the background. We put an end to this sensory overload by unplugging the disco ball and using cellphones as flashlights. We really had nothing to complain about with our hotel though, which was much nicer than what most of us were expecting. We even had hot water for showers most of the time. The cute lizard that liked to hang out with us when it rained was a nice touch too (sorry Macy).
  • When we came back to Accra before leaving to come home, our group was able to visit the New  Horizons School and see the work the Accra team had done there. New Horizons is a school for children and adults with disabilities. The Accra group was able to work the positioning of many of the students who used wheelchairs. The used duct tape, foam, towels, and other supplies from our MacGyver kits to make the children more comfortable. They also fixed up the wheelchairs themselves. It was awesome to see that the group had made such an immediate impact on the children’s lives. Later, we were able to help with training the school staff and University of Ghana OT students on safe transfers. The staff loved this and wanted us to watch them practice to make sure they were doing everything properly. This put our long days of class at Theater Row into perspective.

There’s not nearly enough room here to list all the highlights of our trip. If you’re thinking about going next year, hopefully this post has helped to convince you. It’s worth it!

The Volta School for the Deaf

On our last day in Hohoe we were able to visit the Volta School for the Deaf (VSD) for a quick talk with the headmistress and a tour. As we drove up to the school, I felt like I was on the set of the show Lost. The architecture and design were very original, with the academic part of the campus arranged as a five hexagonal rings of rooms that were raised off of the ground on a platform. We made our way through the school to the office where we sat and talked with the headmistress about the structure of the school and the children they serve. VSD is the only school of its kind in the region. It is a residential school supported by the government and serves 302 students ages four and up in kindergarten, primary, junior, and vocational school. These students come mostly from the Volta region, but some come from as far away as Accra. The school calendar operates around three, three-month terms with breaks in between. My understanding was that all the students are educated using the same core curriculum as students in typical Ghanaian schools. On our tour of the campus we looked in primary level classrooms, the computer lab, and vocational areas of the school. Students in the vocational school can specialize in areas such as batik, woodworking, and weaving. The school also has it’s own pig barn, but I’m not entirely sure of all of its purposes.

Image

 (Inside the academic area of campus)

ImageImage

 (The dorms)

From what we saw, the school seemed to be very well organized and structured, but we also weren’t able to experience the school with the children present. The headmistresses explained that students were not allowed to come back to VSD for the start of the new term because the government hadn’t given them enough money to pay for the children’s food. A quick Google search shows that the government had actually withheld grants to all special schools in Ghana for the term because it wanted the schools to pay for their own supplies and utilities. The impact for the children is drastic. The deaf community is still marginalized by stigma in Ghana. The headmistresses explained that, in many cases, children’s parents and family members at home don’t know sign language and may not be eager to learn. Students who are lucky enough to be placed in a residential school like VSD may end up developing their entire social network around the school. This leaves them without an easy way to communicate when they’re at home, so all of the students look forward to their time in school. Besides the lack of social connection, a disruption like this one obviously affects the quality of education. If this situation had occurred in the US, there would be a public outcry, but unfortunately, the headmistress’s tone didn’t make it sound unusual for Ghana. Luckily, according to another Google news search, the government board in charge of special school education held an emergency meeting soon after we left Ghana and decided to grant funding for the children to return and finish the term.

On a more positive note, when the school is up and running, it helps to support itself through the work of students in the vocational school. A Peace Corps volunteer helped VSD open the “Our Talking Hands” store on the main road running through Hohoe. They sell the students’ work and even have an online Etsy store (https://www.etsy.com/shop/OurTalkingHands) where you can find pillowcases, batiks, table runners, purses, wood carvings, and even some Guinness bottle cap earrings.

Image

 (Murals on the walls in the academic area)

Image

 (Thanks to Meghan for all the pictures!)

 

Some Differences between Rural and Urban Ghana

As part of the Volta group, I was lucky to be able to experience both rural and urban Ghana in one trip. The capital city of Accra and the small town of Hohoe were so different that I might have believed they were parts of separate countries if I didn’t know better.

Our flight landed in Accra on Monday night in the middle of a thunderstorm. As we drove through the city to our hotel, we passed many impressive buildings with modern architecture. Many of us were surprised by the quality of these buildings and the streets, which was about all we could see, but as soon as the sun came up Tuesday morning, we saw more of what we were originally expecting. From our hotel window, we saw shorter buildings of all different colors and states of repair. In the city, the sound of car horns and roosters was constant. Drivers there use horns to communicate their presence to other drivers or pedestrians when going around turns or trying to pick up taxi customers. This took a bit of getting used to since horns are usually associated with rudeness and road rage here. I was also amazed by the number of business signs lining the roads in Accra. They were plastered to the sides of buildings, lined up on poles, on roofs and billboards, and generally in-your-face. I never expected to come back from Ghana with an appreciation for sign regulations in the US.

Image

Image

Image

 (Thanks to Jodi for getting pictures of the signs in Accra!)

We left for Volta Tuesday morning, so we weren’t able to see much of the city, but it was nice to watch the changes in scenery on our six hour ride up to Hohoe. The landscape of the Volta region was drastically different than Accra. I wasn’t expecting to see so much green, which was awesome compared to the inner city feel of the capital. The town itself also gave me a much different impression of Ghana as a whole. All together, it was more of what I had envisioned Africa to be like. One main paved road ran through the middle of the town with a few smaller roads sprouting off along with lots of dirt roads. The main road was lined with shops selling everything from soap, toilet paper, and food, to winter jackets and pots and pans. There were many fabric stores and seamstresses who made the traditional Ghanaian outfits we saw most of the people wearing. The clothing choices in Hohoe were more traditional compared to Accra, where many people wore jeans and other western style clothes. Many shop owners named their stores with religious sayings. This also seemed to be popular in Accra. Besides the smaller specialty shops, we also saw many churches, several government run primary and secondary schools, chemical stores (their pharmacy), banks, a few other hotels, small food shops (one was called the “Decent Food Shop”), and other random businesses.

Image

 

Image

 (Views from the top of Mt. Afadjato in Volta)

Villages in Hohoe tended to be in clusters farther away from the center of town. Some houses were made out of concrete and others were made with mud or bamboo walls. Many of these villages looked just like the stereotypical shots from TV commercials. We saw many more children running around freely in Hohoe than in Accra. The same goes for the goats and chickens. Sometimes it seemed like there must have been at least one goat for every person in Ghana.

ImageImage

Our two groups also had very different learning experiences in the two different cities. The group in Accra gained valuable practice working in more concrete OT related areas like positioning, Denver screening, and wheel chair maintenance. In contrast, the Volta group spent less time working on concrete OT projects and more time learning about the culture and challenges in Ghana through talking with locals and maintaining connections for future trips. Although we weren’t able to work with any disabled children like the Accra group, we did spend a significant amount of time building relationships with the children at the orphanage. This was a highlight of the trip for all of us. Both experiences were equally as valuable, and I’m sure we would all love to go back and switch locations to experience the other city (time to start fundraising now?).

Mr. Sassypants

Meet Bright:

ImageImage

Bright, who we affectionately nicknamed Mr. Sassypants, is a 3 ½ to 8 year old boy who lives at Eugemot Orphanage with his older sister Melody. I went to Ghana knowing better than to “pick favorites” amongst the kids, but Bright’s sassy attitude and goofiness made that nearly impossible. Bright constantly entertained our group with his antics and funny ways of talking. Some of his favorite activities included: napping, making traditional Ghanaian dishes out of mud for us to share with “our people”, swinging, “cutting” Meghan’s hair with his teeth while riding on her shoulders, beating on things with his plastic spoon, and generally getting into trouble (he also loved being tossed up into the air and caught by Nava, but apparently would have liked it more if she never caught him on the way down). For all of the entertainment Bright provided, he gave us equal opportunities to learn about Ghana and how some children grow up there.

When you first see Bright, you would assume that he is between three and four years old. His height, baby belly, and large head for his body all match this age range. After listening to him talk, you’d probably be impressed by his vocabulary, considering his apparent age, which included the appropriate use of the phrase “Jesus Christ” and other sassy sayings. However, if you ask Bright how old he is, he’ll say give you an answer anywhere between seven and nine. This actually became a joke within our group (and still is). Other children and staff at the orphanage also told us that Bright was between six and eight years old. We were well aware that many Ghanaian children, especially those in rural areas and in orphanages, suffered some lasting effects of malnourishment. Malnourishment during infant and toddler years can result in stunted physical and intellectual growth and immune problems. We thought it might be likely that Bright was older than he looked for these reasons, just like many of the kids at Eugemot are, but seven or eight years old seemed like too far of a stretch. Eventually, someone explained to us that when Bright and Melody came to the orphanage, they were so malnourished that Bright needed blood transfusions and almost didn’t live. This helped us make more sense out of the age issue, but it was still hard to be entirely sure.

ImageImage

ImageImage

 (Some pictures to give you an idea of his size)

 A quick solution to this dilemma, if we weren’t at an orphanage in rural Ghana, would have been to pull Bright and Melody’s file from the office and check their ages. Unfortunately, this is much easier said than done. From our perspective, it seemed that record keeping in Ghana was less than accurate. If his birthday were listed in his file, it would have been hard to tell how accurate it was. This, along with the fact that less emphasis is placed on the actual birthday and age of children, leads to confusion about ages for many of the children at the orphanage. Bright was not the only one who gave different answers for his age depending on when you asked him.

Not knowing the exact ages of children makes it difficult to determine how they’re developing compared to their age group. We ran into this problem when conducting a few Denver screenings on some of the youngest children at the orphanage. We made our best attempts at estimating their ages before we began the screenings, but the outcome of the entire test is altered if the age is not accurate. This, combined with possibly being some of the few white people the children had ever seen and the language/cultural barriers, made developmental testing at the orphanage very difficult. Although Bright’s screening probably wasn’t very accurate due to the confusion about his age, it was very helpful in pinpointing cultural differences that could be accounted for when creating a Ghanaian version of the screening. For example, when shown a picture of a cat, many of the children identified it as “bush cat”, and when shown a picture of a horse, most children identified it as a goat.

We also saw some issues with Bright in school. He was usually in a classroom for children who looked like they were in second or third grade, but sometimes could be found in the younger classroom, or just roaming around outside. This is where he liked to run around banging on chairs, desks, and people with his plastic spoon while the other children were working. The lack of structure in this particular classroom was evident when Bright was there. It wasn’t clear if the teacher knew which class he should actually be in, but either way, his needs weren’t being met. The class didn’t seem to have many supplies, the desks were too large for almost all of the children, and it wasn’t clear how involved the teacher was (this may have been off because of our visit). This situation was less than ideal for someone like Bright who needs extra supervision and structure.

Bright has already been through his fair share of challenges and still has many more ahead of him. I’m thankful for everything I was able to learn through him, but will remember his sassy and goofy personality more than anything.

A Little More on the Ghanaian Education System…

 When we left for Ghana, I was expecting to see the country and its culture through a lens of OT and disability culture, but I was surprised at how many issues could be traced directly back to education. We saw many differences between the Ghanaian education system and our own, and some of these differences were beneficial, but many were problematic enough to impact the way we carried out our projects. Some of these issues were smaller in scale like long walks to school and unreliable transportation for the Eugemot children. Others were more systemic, such as the design of the secondary education system.

Some of the immediate problems we noticed were at the Eugemot School. The orphanage and the school are on separate pieces of land about 3.5km apart (that’s about a 43 minute walk for an adult, thanks Google Maps). Eugemot sometimes has a bus to take the kids to school and back but it was being worked on when we were visiting and didn’t seem to be very reliable in general. The kids make this walk regularly, but it’s hard for the younger ones who ended up staying home one of the days the bus was broken. When the kids do have to walk to school, they’re likely to be hot and tired by the time they get there, which creates some obvious challenges for learning. This situation is normal in many developing areas, especially rural ones.

After spending several days at Eugemot’s school, the Peggy Good School of Hope International, we became more familiar with the style of education. The school teaches kindergarten through junior high school students from the orphanage and the surrounding community. We spent most of our time working on handwriting skills and health education in an elementary classroom with students ages four/five to eight. The most obvious challenge we ran into was the style of learning by rote. Good memorization skills can be helpful, especially for the preschool aged children we saw at the school, but when children are only asked to recite something they have memorized in class, this creates problems with independent and critical thinking. Lauren and I ran into this when trying to talk to the younger kids about their emotions for the mental health aspect of Jouette and Nava’s health education project. Our initial approach was to begin with questions like, “What makes you angry?” and “What makes you feel better when you are sad?” This was met by blank stares in nearly every group that came to our station. Obviously part of this had to do with the language barrier and the fact that Ghanaians tend not to show their emotions, but we also noticed that the kids were hardly ever asked open ended questions. If they were asked a simple yes/no or true/false question they could easily respond, but most were not used to vocalizing their own thoughts in front of all of their peers and adults. This problem was still evident in the junior high class. When the older kids were asked questions about preparing for college and writing formal essays, we were met with more blank stares.

The high school and college system has a different set of challenges for students, which was covered in an earlier blog. To recap, students have to test into high school as well as college. If they are not admitted they can still attend a vocational training school to gain skills for a particular job. Students who pass are placed into high schools depending on their entrance test score. They must select an elective track to study in addition to the core curriculum. After high school, students take the WASSCE to enter college. All students are tested on the core curriculum subjects, but they also have to select an elective area to be tested on. This should pertain to the area they want to study in college, but the design of the system pressures students into taking the exam on their high school elective area. It’s hard for a student who did not study a particular elective area in high school to get into that program in college. This means that many Ghanaian students have already chosen their basic career path by the time they’ve entered high school. This system restricts opportunities for discovery and experimentation.

This post can only scratch the surface of education challenges in Ghana. Many schools still use corporal punishment, lack textbooks and other resources for students, offer low teaching salaries, and have very high student to teacher ratios. It’s important to note that even in the US, many of our schools have the exact same problems. Fortunately, Ghana has recently begun working on education reform bills, which specifically target the lengthening of different phases of education, lowering student to teacher ratios, increasing the quality and quantity of technology training, and restructuring the high school system.

Transition Services vs. the Ghanaian Education System

In one of my earlier blogs I wrote about some of the transition services and vocational skills lessons Lauren and I had put together for the older kids (ages 13-22) at Eugemot Orphanage. To recap, we had planned to talk with them about applying to college, writing college essays, searching for scholarships, applying for jobs, making a resume and writing cover letters, opening a bank account, and creating routines. But, as we predicted, basically nothing went according to plan. Instead, the two of us probably gained more from the experience than we were able to give. This happened for two main reasons. First, we didn’t realize how different the Ghanaian education system is from our own, or how restricting it can be for making decisions about future career possibilities. And second, the language barrier and differences in style of education created problems with finding the best way to teach the kids (read more in the next blog).

As Lauren and I prepared our plans for the trip, we learned about many of the major differences between Ghana’s education system and our own, but until we talked to Yvonne (Mama Eugenia’s daughter) and the older kids at the orphanage, we weren’t fully aware of how restrictive their education system can be. In Ghana, students in their last year of junior high must take the Basic Education Certificate Exam (BECE) to be admitted to high school. Admission is competitive; about 375,000 students take the exam and only 150,000 can be admitted. All high school students take core curriculum classes in math, English, science, and social studies, and then pick three or four elective subjects chosen from one of seven elective tracks which include: science, social science, humanities, vocational, technical, business, and agriculture. Depending on which school the student attends, only certain elective tracks may be available. Students’ elective tracks impact their options for programs (majors) in university.

After completing high school, students must take the West African Senior School Certificate Examination (WASSCE) to enter university. Scores from this test place students into one of nine grades. Each university in Ghana has a cutoff grade for all applicants in addition to more specific grade requirements for different areas of study within the university. All students are tested on the core curriculum of math, social studies, science, and English. Students are also tested on an elective track of their choice. These elective tracks are the same as the high school elective areas, so even though students can choose which area they will be tested on, the design of the system pressures them into taking the exam for their elective track from high school. If a student chooses a different elective track to test on, they are not likely to do as well in this area and universities will still select students who were educated on that track in high school over those who weren’t, even if they have the same score.

If all of this sounds too confusing, that’s because it is. This system basically requires students to have a clear vision for their life by the time they are finishing up junior high. If a student started high school thinking they wanted to be a teacher, but then gradually realized they really wanted to be a doctor, their options would have already been restricted, making this switch extremely difficult. One of our mistakes in approaching this project was to assume that an 18 year old in Ghana has the luxury of not knowing what they want to do with their life just like 18 year olds here in the US do. Although many Ghanaian teenagers still have absolutely no idea what they want to be when they grow up, their path has basically already been laid out for them, and nothing that we had prepared for them acknowledged this.

If I could go back and change my plans, I would have chosen to focus more of my attention on helping the junior high and under age group become more aware of their options. This is when kids in Ghana need to be thinking about what subjects they are best at and which they enjoy the most. We noticed that many of the kids tend to idolize certain professions without knowing what they actually entail. For example, one boy said that he wanted to be an accountant when he grew up, but then said that he didn’t like math. Future groups could focus on talking with the children about popular professions and what type of work they involve as well as which subjects they draw from. Less mainstream careers should also be focused on. When asking kids at the orphanage school what they wanted to be when they grow up, we probably heard no more than 5-7 different responses. It seemed that many kids simply weren’t aware of the diversity of jobs available to them. Even in a developing country, there are plenty of options beyond doctor, nurse, accountant, soldier, and teacher. Educating the middle school aged kids on different jobs (as well as the importance of finding a good fit for high school electives) would be an easily manageable project for a two-week trip. Focusing more on the young kids doesn’t mean we should be ignoring the older kids though. They could still use help with learning how to write good college essays, create resumes, apply for jobs, and develop routines, but the delivery should probably be changed (read more in the next blog).

So What Will You Be Doing in Ghana? by Lily

This time tomorrow night, we’ll be over the Atlantic Ocean on the way to London and then Accra, but I still haven’t found the perfect response to that question. My short answer is something like ‘working with kids who have disabilities and kids in an orphanage in the rural part of the country’. But that obviously doesn’t even begin to scratch the surface. A better response might be: wheelchair positioning, transfers, and repair, providing services to kids who have difficulty with feeding, modifying games and tools to be more accessible, handwriting instruction, health education, conducting developmental research interviews and teaching transitions and vocational skills for young adults at the orphanage. The only thing missing from that list is ‘other’. One thing I’ve learned on my previous trips to developing countries is to throw all expectations out the window. Not in the, “If you never have any expectations you’ll never be disappointed” kind of way, but more in the go with the flow and fly by the seat of your pants kind of way. I’ve learned that no matter how prepared you are or how detailed your plans are, something is bound to go differently than you expected. It’s actually one of my favorite aspects of travelling.

But here’s what I do have planned. Over the past few weeks, Lauren and I have been putting together the transition services and vocational skills projects for the older kids at the Eugemot Orphanage. The kids we will be working with range from 13 to 22 years old and will be leaving the orphanage soon. Just like kids who graduate from foster care here in the US, these kids at the orphanage will need help adjusting to life on their own. We’ve put together information on how to fill out university and job applications, write a personal essay for college, search for scholarships, approach a job interview, make resumes and cover letters, and open a bank account and save money. This is our plan, but we’re anticipating lots of change once we arrive. University applications, for example, might end up being something that the kids can actually teach us about since we really aren’t experts on the Ghanaian education system. I think we will be approaching these projects as a collaboration. Once we find out what skills they do and don’t have, we’ll better be able to target specific areas where they need the most help. I’m looking forward to it being a learning experience for all of us.

The State of Rehab in Ghana by Lily

          Since I’m a little late to the blog posting game, I was struggling to find something to write about that hadn’t already been covered by one of my classmates. Then I remembered this video (http://www.youtube.com/watch?v=pnQl9VYtSB8) found by a doctoral student travelling with us that I had yet to watch. The video, made by the International Rehabilitation Forum, discusses the state of rehab services in Ghana and follows Tom Haig as he travels through the country using his wheelchair. During the course of our Tuesday lunch meetings during the spring semester, we have learned about the various disabilities we will encounter in Ghana as well as the culture and support for disabilities there, however this video was very helpful in tying everything together and helping me understand what to expect.

          The current rehab situation in Ghana is generally not good, but is still better than what many developing countries are working with. Throughout the video, Mr. Haig visits several hospitals and medical schools across Ghana. Most of these hospitals have a physical therapist, but occupational therapy is not mentioned and does not seem to be well integrated into the healthcare system. Because of these limited medical resources, Ghana has implemented a community based rehabilitation program (CBR). The major goals of the CBR program are to promote rights of people with disabilities by raising awareness and mobilizing resources, to establish links between health care providers and the community, and to strengthen the associations for people with disabilities.

          A huge attribute of CBR is the network it has created between people with disabilities. Ghana now has one of the strongest disability advocacy groups of all developing countries. In 2007, the group had a major role in getting the Ghanaian Disability Act passed. The act includes provisions on basic human rights, employment, education, transportation, healthcare facilities, and inclusion in national activities. Although the new laws may sound good on paper, Ghana is still having trouble putting them into action. This is evident when cameras follow Mr. Haig as he navigates through Ghana. A recap of some of the problems he encounters:

  • Only the main streets are paved and all the rest are bumpy dirt roads. During the rainy seasons, this means that people using wheelchairs may be blocked off from the rest of the community for hours or even days.
  • Trenches carrying drainage and waste run alongside the length of many roads with sometimes only a few boards laid to cross over, creating more obstacles for people using wheelchairs.
  • In the capital city of Accra, Mr. Haig discovers that able-bodied people are able to catch vans into the center of the city for what is about the equivalent of one US dollar. Unfortunately, these vans won’t stop for people with disabilities, forcing them to pay up to the equivalent of $25 for a taxi ride. For some Ghanaians, it could take weeks to make that much money.
  • The vast majority of old buildings do not have ramps or elevators

           While CBR is a good idea in theory and has brought a significant amount of change to Ghana since the time it was implemented, there is still a problem of the medical aspect of rehabilitation being ignored as soon as the family, community, and advocacy groups step in to assist a person with a disability. One rehab expert has compared community-based rehabilitation in Ghana to community-based neurosurgery. Often times, once a person is released from the hospital, they return home to their family who is unable to pay for medical equipment and supplies or modifications to their home like widened doorways for wheelchairs. When this happens, many people simply end up being left at home with no way to interact with community or live a normal life. Lack of proper medical equipment is also an enormous issue and forces many Ghanaians to construct their own makeshift devices (scroll to the 13:05 mark of the video to see a wheel chair made out of a white plastic lawn chair).

            Now I’ll try to end on a positive note. Many of the problems Ghana faces in regards to the medical aspects of rehabilitation can be addressed by occupational therapists. Our group will be working on some of these issues, including wheelchair positioning and modification and modification of toys and tools to allow children and adults with disabilities to play and work in their natural environments. We will also be educating staff at centers for people with disabilities on proper positioning and modification of wheelchairs. Near the end of the IRF video, a Ghanaian neuroscience professor offers her view on the state of rehab in the country today. She says that Ghana is very close to attaining a self-sustainable rehab culture, but still needs a little push in the right direction. I think I can speak for all of my classmates when I say that we are very excited to be a little part of that little push.