Trials and Tribulation with Health Education by Nava

The lesson plan I was assigned to work on with Jouette was health education. Before leaving we planned a few different sessions that we hoped to be able to adapt for different age groups in different settings as we had no idea what age groups or in what setting we would be working with kids in before we left. We prepared these short sessions so that they could be grouped together in a variety of combinations with ice breakers and activities. As many others talked about in their posts, we did not anticipate the differences between American and Ghanaian culture in how classes are taught and how students are expected to behave. All of our plans involved student participation and that is where we experienced our biggest hurdles.

The classrooms for 7 and 8 year olds that we spent most of our time in had ample room with desks and chairs for each student and a large blackboard up front. The children mostly behaved according to the expectation that they would sit in their seats and perform rote memorization of the lesson.The lessons we observed consisted of the teacher explaining something and the students repeating it back. We didn’t see any examples of students being asked to provide answers demonstrating comprehension or critical analysis.

Kids at orphanage practicing handwriting

Kids at orphanage practicing handwriting

Jo and I created mini lesson plans on personal hygiene, basic emotions and coping skills, relationships and appropriate physical behaviour, smoking, and healthy eating/food pyramid. Most of it was geared towards the 7-9 year age range with the ability to simplify for younger kids or grade it up for 10-15 crowd. We also put together role playing and information on relationships and consent aimed at more of a teenage audience. We only had the opportunity to execute these lesson plans with the 7 and 8 year olds and decided, after teaching them the hokey pokey, to break them up into three groups. The groups rotated between three stations each lead by a pair of OT students that covered oral hygiene & taking care of your skin, emotion health and coping strategies, and how to stop germs.

After completing all the rotations, catching our breath, we headed back to our hostel on the way, had a little debrief of the experience. At each station, students had been responded with silence to simple open ended and we always eager to repeat a suggestion provided by us ‘teachers’. They appeared to listen and be somewhat engaged when learning about oral hygiene, skin care, and germs but were rather disengaged on the topics of emotions and coping strategies. The children to regularly perform teeth brushing of some sort and wound care but still struggled to tell me about it when prompted. Emotions seemed to be foreign concepts to them. The only responses they were able to provide were that they were sad when they “got beat” – a common parenting practice in Volta. Talking about putting names to feelings and the idea that one would discuss feelings with a confidant only brought blank stares and wiggly feet.

An interesting contrast to this experience was how the children behaved out of school. There was one 13 year old girl we met in the older classroom when some of my group-mates were teaching transitional skills who seems pretty quiet and disengaged. A day or two later when we visited a village to conduct interviews with mothers, she approached our tro tro (van) and chatted with us for probably about 30 minutes. She had so much to say and answered questions about what she wanted for her future, her favourite activities, her family, etc. She bounced around as she asked us tons of questions about our families, our favourite foods and shared her story. This was a drastic contrast to the personality she displayed in school. She was clearly bright, active, and inquisitive. Meeting her outside of the school context provided us with an interesting idea of how students adjust their behaviour and attitudes based on the expectations in the classroom.

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Disability and Stigma in Ghana by Jouette

This post is related to Lilly’s last post and the video that she talks about in her post. Great minds think alike. Instead of finishing my packing, I decided to procrastinate and watch a video that one of our fellow group members, Kate, shared from the International Rehabilitation Forum. The video (watch here) delves into disability awareness and the status of rehabilitation medicine in Ghana. It got me thinking about the Ghanaian attitude surrounding disability that we have discussed quite a bit. Many Ghanaians view disability through the lens of their traditional spiritual beliefs; they believe that disabilities are a spiritual problem, or they are caused by witchcraft or spirit possession. In a society where everyone is expected to contribute to the survival of the family, individuals with disabilities are considered a burden on their families.

In Ghana, individuals with disabilities face stigma daily. Many people refuse to hire them and buy goods from them, and most van drivers refuse to pick them up and take them to work. Children with disabilities are often sent to special schools away from their families because their families are also stigmatized for having a child with a disability. This stigma is one of the largest barriers to work and community participation. The only option for many individuals with disabilities is to move to the urban areas and beg for food and money.

There have been some improvements in government support of disability rights. In 2006, a Disability Rights Bill was passed in Ghana which established a National Council on Persons with Disability and set a goal of providing disability services and equal employment opportunities to persons with disabilities by 2016. This will be a daunting task considering the lack of government funds and poor infrastructure in Ghana.

I also found it interesting to learn from the video that the disability community in Ghana has organized itself into local Disability Councils even in the most remote areas of the country. Many of the individuals in the video traveled long distances on hand bikes to participate in these meetings. The video also showed examples of individuals with disabilities who were successful in finding employment to provide for their families despite the stigma they face. These individuals also appear to have been accepted by their local communities.

I am excited to get the chance to talk to the staff members who work with children with disabilities, and I am curious to see how their views differ from the general societal views on disability. I also hope to get the opportunity to change attitudes about disability by sharing my views about the contributions that individuals with disabilities can make to Ghanaian society.

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.

Akwaaba to the Rich Cultural Heritage of Ghana by Laura

In a few days we arrive in Ghana. We’ll be doing lots of “snapping” (with permission of course) from the individuals whose pictures we are taking. Although primarily English is spoken there, “Akwaaba,” which means “welcome,” is a common greeting (Ghana Tourism: http://www.touringghana.com/default.asp) we will soon be hearing. I’ve been practicing several other Akan greetings suggested by Ghana tourism:

Medaase: Thank you

Mepaokyew: Please

Maakye: Good morning

Maa ha: Good afternoon

Maa-Adjo: Good evening

Da-Yie: Good night

Nantee-Yie: Farwell

The family to which you are born and/or the day of the week on which you were born are of great significance to many ethnic groups within Ghana. GhanaWeb has a detailed article about Ga birthing rituals and naming traditions, which can be accessed with this link. After giving a present to all individuals who assisted in the birth, which is typically washing rum, the father sends one of his cloths, which is used as a pillow the newborn. This is described as ‘absolutely necessary’ as it is formal recognition by the father that the baby is his child. Eight days after the child is born the mother and father’s families meet at the paternal grandfather or father’s home in the wee hours of the night. Although this does not do the ritual justice, it involves an individual in good standing sprinkling water onto the baby, the father’s family naming the child, and the eldest person present saying a blessing for the child and his or her family.

Children are often given family names. Naming traditions for the Ankrahs, Ama, Kwate or Kpakpa, and Damte families are discussed, in addition to stool names. Stool names are given to children of families who occupy stools and are described as “the greatest of all names.” The article indicates that some Gas may also go by the day of the week on which he or she was born. This practice originated among the Twis and uses Twi language of the Akan people. As I was born on a Friday, if I had born in Ghana and received a birthday name, I might be called Afua. This site  provides a great chart of birthday names for males and females with audio clips to aid in proper pronunciation.

I’ve also learned that we will be in country on African Union Day, which is May 25th. This year will be the 51st celebration of the Organization of African Unity (OAU), which became the African Union (AU). This multi-national organization “seeks to promote ‘an integrated, prosperous and peaceful Africa, driven by its own citizens and representing a dynamic force in global arena” (http://summits.au.int/50th/about). It may also be referred to as African Liberation Day since this day marked the end of colonialism. Unity, solidarity, Pan-Africanism, and Renaissance are celebrated. Ghana’s Headlines Educational Center (2012) indicates that throughout the African Union children wear traditional African clothing to school. Also, a Ghana Armed Forces’ (2012) news article suggests traditional celebrations include a flag raising ceremony in Accra. It will be a privilege to be present on this day.

Learning About Ghana by Nava

In this post, I (Nava) am hoping to build on what Sam posted about yesterday regarding Ghana being unfamiliar and unknown. I’m going to spend the morning doing some research and present a small window of whats going on in recent Ghanaian news and politics. As our trip approaches and we continue to work on our projects to prepare, many of us have been asking more detailed questions regarding the modernity of the locations we’re going to and what we should expect. We’ll be able to report more on that in approximately 6 days (whoa) but hopefully some factual info on the state of the country will help provide framework for my mind to build on once we land!

Politics/Finance

  • Government Overview: Ghana currently maintains a parliamentary democracy with a history of military and civilian rule. The executive branch is lead by current President: John Dramani MahamaThere are 40 political parties represented, the largest being The National Democratic Party, New Patriotic Party, and the Conventions People’s Party. Ghana is divided into 10 regions and there are 275 electoral constituencies. Ghana has yet to have a female leader.
  • Legal System: The Ghanaian legal system is based on the British Common law, traditional law, and the current constitution.
  • Foreign Relations: Ghana maintains non-alignment with any major power bloc and is an active member of the UN and African Union. They have had many representatives serve as international diplomates including former UN Secretary General, Kofi Annan.
  • Currency: Ghana uses the Cedi which has not been doing terribly well. As of today, the rate is $1USD = 2.8GHS (source)
  • Accountants: The Institute of Chartered Accountants, Ghana (ICAG) is currently celebrating National Accountants Week to celebrate and share the importance of the role of accountants as custodians of the economy of nations. Fun note: Their president is Mrs Angela Peasah. Her mission includes cutting down on government financial corruption (source, source)
  • Some Major Online News SourcesGhanaWeb, DailyGuideGhanaVibeGhanaGraphicOnline,

Sports: The first thing to pop up when one google news searches Ghana is WORLD CUP SOCCER! the GFA just announced the 26-man roster for the 2014 world cup line up being lead by Captain Asamoah Gyan. He and Sulley Muntari will be the most veteran players returning for their  third consecutive World Cup. Ghana, known as the Black Stars,  will compete in group G in the world cup along with Germany, Portugal and the U.S. Another cool piece of Ghanaian football trivia – Kwesi Appiah will be the first Ghanaian coach to coach the Ghanian team at a world cup. Sadly, we will just be missing the end of the local league season so we wont be able to attend any games but I’m sure we’ll be playing a lot of pick up (source).

There is little news to be found about other sports however I have found headlines regarding:

  • A new development training program for Ghanaian weightlifting coaches (source)
  • Preparations to send four tennis athletes to Europe to train for the Davies Cup as well as a new sponsor to help them with gear (source)
  • In honor of a football riot resulting in multiple deaths 13 years ago, a fund was created to support the families of those who died. This year the fund announced that although not part of their mandate, they decided to ensure each child of the deceased will be educated to the tertiary level. Currently, this means funding education for 90 students. (source)

Technology

  • Mobile Banking: Guarantee Trust Band (Ghana) just introduced online checking deposit to allow customers to deposit checks without visiting a branch location which is a first for Ghanaian banks (source)
  • Smart Farming: The NGO, TechnoServe,  has introduced its flagship Mobile Training Unit (MTU) to support and improve farm level productivity of smallholder farmers in Northern Ghana. (source)
  • Electronic Waste Dump: Very interesting slide show and article about Agbogbloshie, the world’s biggest e-waste dumpsite and is located close to Accra. Electronic waste – TVs, PCs, HiFi systems, refrigerators – now fill a former wetland and recreation area

So that certainly doesn’t cover everything. I haven’t gotten to healthcare, corruption, political history, education, rural vs. urban…but its a start towards seeing the bigger picture of what Ghana means. While I’ve only put links and headlines here, reading through these articles and the ones that didn’t make the posting cut, was really helpful in getting an idea of the political climate and news outlet priorities. I’m curious to see how these facts and headlines related to the realities of life once we land. If there are any questions you have about Ghana or areas you think might be good for me to research before we take off, feel free to comment!

Lisa Kristine’s Modern Day Slavery Photo Essay by Nava

My mother actually found this link to a woman who has done some amazing photo essays, Lisa Kristine. One of her photo essays is titled Modern Day Slavery and captures images of adults and children in Ghana, India, and Nepal who are currently indentured slaves or trapped in debt bondage. While this topic is not directly related to our trip, I feel it is a link worth sharing for the purpose of  bringing awareness to the issue. Many of her pictures are of  very young children forced to work in fishing boats on Lake Volta. They are deprived of basic necessities such as health care, proper nutrition, and education not to mention the psychological and emotional consequences this children may face. The Ghanaian government prohibits all forms of trafficking through its 2005 Human Trafficking Act however in 2012, the UN said that Ghana is not yet compliant with minimum standards for the elimination of trafficking. Enforcement occurs through the Anti-Human Trafficking Unit. Additionally, there are a few NGOs such as Challenging Heights and PACODEP that work to protect the rights of these children by withdrawing them from compromised living situations, educating local fishermen, and helping to support rescued children in developing healthy futures.

This issue of slavery can be related back to occupational therapy through the concept of occupational justice, a type of social justice. This is the idea that all individuals should  have the right of equal access to occupational opportunities. Occupations are defined as personally meaningful activities. This is a concept that we will be promoting on our trip by working to adapt tasks, modify tools, and teach children strategies to access and participate more independently in their occupations.

Planning & Preparing by Nava

With 40 days till we take off, this trip is starting to feel a lot more real than it was just a few weeks ago. I’ve traveled to a few different places around the US and internationally before but I expect that the cultural differences we will be experiencing on this trip are probably going to have a higher contrast to life in North America than those I’ve experienced in the past.

Our trip group has been meeting every other week for the past 3 months to discuss a variety of literature and information that will help us be prepared to be effective and informed on this trip. In our first meeting, we learned a bit about the two different locations our group will be in, Accra and Volta, and the different settings we will be visiting. Accra is the capital and largest city in Ghana and the students going there will be working with the Grace International School, Eban Foster Home (in Teshie), the New Horizon’s School and the Feeding Program for Street Children. The Volta Region is the most eastern region in Ghana right along the border with Togo. The students going there will be working with the Eugemot Orphanage, Volta School for the Deaf, and the Gbi Special School.

In the following meetings we’ve covered a gamut of topics from cultural standards (don’t cross your legs!) to disability law to common illnesses and a whole lot more. From the beginning of the application process for this trip, my biggest worry is that as a first year occupational therapy student, I won’t yet have the skills, knowledge, or experience to be able to really help during this trip. Some of these fears have been calmed as I’ve gone through my first fieldwork practice in a clinical inpatient setting. I’ve been able to put the concepts and strategies we’ve learned in class into practice and proven to myself that I can think creatively on my feet to create effective treatment plans with patients. Working with the educators and children in Ghana will be a great opportunity for me to use that skill set in a whole new context.

In our last few sessions before we depart, we will be shifting from the conceptual bigger picture of visiting Ghana to focusing on the practical skills we will be using such as positioning, environmental adaptations, and practicing the developmental assessments we will use. In addition to reading up on and practicing these skills, I will be putting together health education programming for children and youth of all ages for us to use in Accra and Volta. I’ll post more about this as it comes together but to give you an idea, we will cover things like basic hygiene and ideas of personal space with younger kids and safe sex practices and safety awareness with the older kids. I have also just completed research ethics training and will be assisting Kate, the Doctoral candidate in our group, with completing interviews for her research project. These next few weeks should be a lot of fun!

 

Appreciating Ghanaian Culture by Macy

Reality has set in—I just received a confirmation email that my ticket has been purchased!  I am feeling a mix of emotions about leaving the country, but mostly excitement about seeing a new part of the world and making a difference in Ghanaian children’s lives.  I have always had the desire to study abroad and never followed through with the process, but I knew the time was right.  To me, this is my last opportunity and I refused to pass it up.  I am nervous that I will not be prepared for the different lifestyle that we will experience, but I am ready to be flexible and learn so much from Ghanaian culture.  My family is nervous for me to take this trip, mainly because nobody in my family has ever done anything like this before and they are worried about my safety.  But it makes me feel better that my professors are bringing their children along too—they would never take their own children if they felt it was unsafe!

Reading about Ghanaian culture makes me appreciate all that we have available to us, and I am realizing that we take a lot for granted.  For example, many children in the US complain about going to school, but in Ghana it is a privilege to receive an education, and they will walk miles each day to get to school.  I was surprised to find out that students in Ghana are required to wear uniforms, but they have to purchase them on their own, along with books and other needed supplies. I am so excited to help these amazing children that are so appreciative and hard working!

During our talk with Randi Buerlein, I found it interesting learning about some of Ghanaian culture “do’s and don’ts”.  Things that we do subconsciously in the US, such as crossing your legs and using the left hand, are offensive in Ghana.  These are things that I need to train myself to consciously think about to avoid offending the Ghanaians.

The projects I will co-lead while at the Eugemot orphanage in the Volta region include handwriting programs and after school games.  I am planning to meet with my co-leaders within the next couple weeks to start planning, and will be sure to keep you up to date on our progress!

The date of departure will arrive before I know it, but there is still so much to learn and prepare beforehand. However, I am very grateful for this opportunity and will continue to soak in as much as I can during our discussions each week to prepare the best I can for this amazing adventure!