There’s a void in the centre of Ghana

Basic Needs, the organisation we are working with, started its operation in the North of Ghana four years ago, and set up a second office in Accra in the south two years later. From our work so far it has become clear what has been achieved to date, and what still needs to be done. Yet there is a gaping geographic hole – they have a presence in Northern and Southern Ghana but nothing in the centre of the country. It is for this reason that we’ve spent this week in Kumasi, which is the capital of the Ashanti Region. It is Ghana’s second largest city after Accra, with a population of over one million.

We have tried to turn it into more than just a ‘fact finding’ tour. It has been like setting up a new business in a ‘greenfield’ site – we have had to meet local stakeholders to find out what the situation is with regard to mental health care provision, and explaining what Basic Needs does and how it operates. Examples of the variety of people who we have met over the last few days include

* Regional Director of medical services
* Chief Executive of the Regional Hospital
* Dean of the medical school
* A number of Community Psychiatric Nurses
* Psychiatric education team

We also split up with Evans from Basic Needs so he could meet another NGO (‘non governmental organisation’) that works in the mental health sector, and visit another hospital.

It has been a very interesting week which has highlighted a number of issues to be addressed. Two specific examples include

* legitimacy: the people we spoke to now understand what Basic Needs does and how it can help, but there are other we could not speak to who are important (eg the Regional Minister, who we hope to see in a couple of weeks, and the Metropolitan Director of Medical Services). Before any more time is spent developing the organisation here, we need all the stakeholders to understand its purpose and accept its legitimacy, as the co-operation of the Health Service is clearly key.

* partner organisations: a lesson learned from the Northern Region is that rather than do everything itself, Basic Needs works with around eight partner organisations such as providers of micro-finance. Essentially it is increasingly trying to be a facilitator or catalyst for other organisations to come together around the mentally ill, rather than be a ‘fieldworker’ itself. Our work over the last week has highlighted that there are comparatively few NGO’s in the Ashanti Region, which means we need to take a careful look at how Basic Needs best uses its limited resources – should it build its own organisation in the region or should it try to develop the capacity of other organisations that it will work with.

We had a very good closing meeting with Evans last night where we discussed our views on what should be done next. All these issues are coming together in the overall strategy that we are developing with Basic Needs to help them look forward over the next five years.

During the week we also took time to visit Kejetia Market which is the largest open market in West Africa – over 10,000 traders operate within a 12 hectare site. It was mayhem! I have been to a few markets in my life, including a pretty busy one in Istanbul, but this was something else. There were so many people packed into such a small space selling all sorts of stuff:



I am not claustrophobic, but the feeling of being squashed in a tight space, often in alleyways with no light, was intense. Everywhere you looked were people shuffling about – it feels like this market provides food and household goods for the whole of West Africa!


I have a guidebook on Ghana which says “aside from the decidedly smelly part of the market where fish and meat are sold, this is a fascinating place”. I found the whole market decidedly smelly, but with a comment like that we had to check out the fish and meat sections! Here’s a picture from the fish bit – if only you could get the smell from the photograph…



That was nothing compared with the meat room. This was a darkened room where there were about 200 butchers chopping up animals. We glanced at each other with a nervous smile before entering…



Notice Robbie has his hands in his pockets – I kept mine in my pockets as everyone wants to shake your hand, which normally is great, but not when they have just been arm deep up a cow! Speaking of which, check out the fake smiles as a man displayed his merchandise to Jose-Luis and Robbie…



I found the meat room nauseating – hot, dark, and very smelly. Robbie was just getting over a tummy bug, and Jose-Luis was just starting to suffer from one, so I don’t think this market helped! It was, however, an experience to remember.

We are off back to Accra today, having been away travelling around the country for over three weeks. Whilst working in Kumasi here are two of the many things that have made me smile:

* On the back of most tro-tros (little minibuses that everyone uses to get to work), the driver usually paints a great quote from the bible such as “God will guide me” or something like that. One chap was more modest with the quote “Simple man. Some friends”!!!

* We drove past a restaurant shop (more like a shack) on the side of the road which had a picture of a rat and the quote “Bush meat sold here”!

How do you deal with a psychotic who goes wandering in front of cars?

That is the question facing the parents of Abu, a 25 year old psychotic who started wandering in front of traffic completely oblivious to where he was. Along with 95% of Ghanaians they turned to a traditional healer who prescribed a treatment of herbs and restraint. The restraint involved Abu being confined to a dark room and having his leg attached to a tree trunk. When we met him on Thursday he had been there for over a month…


Restraining patients by chaining them up or attaching them to tree trunks is not unusual. In the case of Abu, his leg was inserted in a hole in the trunk, and then an iron nail inserted to prevent him removing his foot. He had to eat, sleep and spend the day in the room, with the constant weight of his foot underneath a tree trunk. The scene was almost medieval and one that I will not forget easily.


We heard about this case through Walter, a psychiatric nurse based in Wa where we were staying. Walter administered some tranquilizers which would last six weeks, and this would control Abu’s tendencies to go wandering. However in order to secure Abu’s release, the traditional healer would need to make a sacrifice of a chicken or fowl, so the next day his parents would pay some money for the animal and call the healer. Only then could he be released. In some circumstances where the family is too poor, Basic Needs have had to pay for the animal to be sacrificed in order to release a mentally ill person from their restraint.

We met an association of traditional healers then next day at their monthly meeting, and we raised the sensitive issue of chaining and restraining patients. Before the meeting we had met the chairman of the association at one of our training sessions for Basic Needs’ partners, and at the meeting the chairman stood up and talked to the other healers about the benefits of “white man medicine’s” tranquilisers which can stabilise patients without the need for restraints, before they go on to administer herbal remedies. This was the catalyst for a number of other healers to stand up and talk about their experiences combining the “new medicines” with the “traditional” approaches, and this avoided having to chain people up for months on end. Some healers, however, stated they never used the “new” medicines – implying that they did indeed use some pretty rudimentary and backward approaches.

It has become clear from our conversations with many people that there is a real gulf of distrust between the traditional healers and the modern medical community, yet the traditional healers are at the front line of care for most of the population. Later on Friday we had a very productive session with Peter, head of Basic Needs in Northern Ghana, on how to take the organisation forward, and this was one of the topics we discussed.

We have now left Northern Ghana and travelled south to Kumasi, the second largest city in Ghana and the principal city of the Ashanti Region:


This was SUCH a tedious drive, much of it on dirt roads, taking almost the whole day. The Ashanti Region is virgin territory for Basic Needs – no self-help groups for the mentally ill, no psychiatric outreach clinics, none of the support they provide to transport psychiatric doctors up from Accra – and therefore an area with much to do.

Before we left Wa in the North, there were more (inevitable) hordes of kids who were so excited to see us. Here is Robbie trying to teach some of them yoga (he does his yoga every day) – some of them clearly couldn’t balance too well and were toppling all over the place:

And I love the expression of the kid on the left in this picture – he was absolutely hyper when we came across him and his excitement rubbed off on all the other kids, who wanted to see their own picture on the camera screen!


Finally this weekend there has been a major incident involving a baboon. The police are using the more common local term of a “babincident”. Here is a picture of the offender and some of his criminal gang just before the babincident:



It just ran out from nowhere and grabbed Robbie’s bag which contained his camera, pictures of his family and some flags from New Zealand that he was about to give to some kids at the local village. The baboon then ran up a tree and started going through the bag, dropping things out onto the ground. When Robbie and others tried to get the bag back, the baboon then charged at him but luckily backed off.

We reported the crime to the local police and they ran a check on their national database and came up with a hit. Here’s the photo from when the baboon was last in police custody:



I am therefore making a public appeal – if anyone sees a baboon’s tree decked out with New Zealand flags and pictures of Robbie’s family, it is highly likely to be our suspect. He may even be wearing my underwear that he stole a few weeks ago – see my earlier entry in the blog. Please approach with care – he may be dangerous…

Where is all of this going?

We have now moved to Wa, capital of the Upper West Region, and this was a six hour drive on dirt roads from our previous base in Bolgotanga.

Mental health development here is far behind many other parts of the country, mainly because it is so remote and infrastructure is so poor.

I’m conscious that in the past few entries I’ve talked at length about our day-to-day activities including some of the people and group’s we’ve met, but less about what we are trying to do.

One of the main objectives of our work is to help the Basic Needs team look forward and ensure their organisation remains relevant to the many aspects of helping the mentally ill. We are doing this by helping them develop their strategy for the next five years. For a team of three people with very little experience in working in healthcare (and none in my case), that has meant spending so much time just speaking to people and listening.

It is through this listening process that we have identified a number of themes and issues which we are now discussing with the Basic Needs team as to how they impact on the organisation going forward. Examples of themes include

* Fieldwork: continuing to expand the work in the field, such as encouraging the mentally ill to come together and form self-help groups. Our discussions in the Upper West Region highlight how far behind they are compared with, say, the Northern Region.

* Advocacy: working with the Government and the Health Service to encourage mental illness to be treated as a priority area and within the primary healthcare system.

* Sustainable livelihoods: treating the mentally ill is only one part of the equation – they also need to be re-integrated into their communities, for example by helping them gain employment to avoid them being always dependent upon others.

Examples of some of the issues that we are working on include

* There are only three psychiatric doctors currently operating in Ghana, principally because of a ‘brain drain’ to the UK, Germany and US (I heard a comment from the head of a hospital there are more Ghanaian psychiatric nurses in New York State than there are in the whole of Ghana!). Short of matching salaries with the developed world, can the country persuade doctors to return for a week or two a year, to attend clinics which Basic Needs could facilitate?

* There is a new law which comes into force at the end of the year which will require each Regional Hospital to have a ward dedicated to mental health with (if I recall correctly) 10 beds. I raised this with a hospital director who laughed at this – his hospital had no such ward and could not ever foresee one given his budget. It does represent an opportunity to take the government to task (it sets the hospital budgets, it also sets the laws), not necessarily to ‘win a test case’ but to raise the profile of the lack of mental health capacity.

These are just examples of the issues that we are discussing in order to shape the strategy for the next five years.

When we return to Accra at the end of next week, we will expand our work to cover the second of our two objectives: working with the Ghana Health Service to revisit a Community Mental Health and Development plan that was prepared in 2002 to ensure it is relevant to the new Mental Health legislation.

In the meantime we have also doing more training for Basic Needs’ partner organisations. Yesterday and today we ran a workshop for much of the day for organisations such as the health service (eg psychiatric nurses), the Department for Community Development, microfinance groups and a traditional healer. We covered the same areas as the training session last week (microfinance, business planning & project management, and cultural diversity), and whilst I am getting a bit bored of doing the same training sessions over and over again, they seem to be going down very well. Here is Jose-Luis talking about microfinance:

We’ve also been spending time doing more one-on-one coaching with different individuals we come across. It is very similar to coaching in the office environment, and the issues are often the same (such as ‘where do I go from here?’), just the context very different.

We will spend the rest of the week up in Wa, with a few more meetings (we will be seeing a traditional healer in action for the first time on Friday), but the rest of the time will be starting to bring the issues together with the Northern Ghana team. Next week we will then travel down to the Ashanti Region in the middle of Ghana before returning back to Accra in the South at the end of next week.

We are now about half way through this programme. When I look back on the last month, the most difficult time was probably the first couple of days when we first witnessed how some of the mentally ill are treated in communities beset by real poverty. The highlight? There are so many - from the warmth of the Ghanaians to the stories behind some of the individuals we have met. However, overarching this is the fact that I am working with a great team – Jose-Luis and Robbie are top guys and we’re having a lot of fun. This programme would be a complete misery if we didn't get on well, as we spend so much time together.

Finally here’s a picture from this weekend. We went with Adam from Basic Needs to a lake that had crocodiles in it – and forgot to shout “behind you!”

Some people only want you to listen to their stories

We’ve been out of internet contact for the last week, so it has not been possible to update this since Monday. Internet access remains very difficult so updates are likely to become more far between.

On Tuesday we took the Nissan Patrol into some pretty rural areas. The roads were atrocious, and for 2-3 hours this morning the car was jumping all over the place as it dealt with some washboard road surfaces that had my eyes buzzing. We probably only travelled 40 miles…We attended a self-help group which met underneath a mango tree. We’ve been to a few of these before, but they are very useful as they are an opportunity for us to hear first hand the issues the mentally ill and their carers face.





It is very common in Ghana for groups to come together to help themselves. What Basic Needs does is to facilitate groups of mentally ill people to gather for the first time to swap their own stories and experiences. As an example, at the group on Tuesday this man talked about how he had benefited from micro finance to buy the tools to become a cobbler – he has now paid his loan back and his new trade is helping his integration into the community.

It is also clear what a burden a mentally ill child is on the parents, and this is exacerbated when the family lives below the poverty line, with many families earning less than $100 a year. Here is Robbie with one of these children – we did not understand what was wrong with her.

After the meeting we went to meet two mentally ill people. The first was a 25 year old woman called Alicia who was epileptic. She had a big scar across her throat where she had fallen into a fire during an epileptic fit, and another wound on her arm where she had scraped it on the ground during another fit. Here she is with her family – father on the right, mother and siblings on the left.

She was pretty withdrawn during our conversation as she was recovering from a fit a couple of weeks ago which still affects her. Drugs help increase the length of time between convulsions but they do not stop them. What amazed me was how grateful her father was for the visit. There is a stigma against epileptics, and people will steer clear of someone having a fit for fear that touching them will give them bad luck (despite the fact that epilepsy is not contagious). To have three ‘white men’ come and just listen to her story was a sign to her community that she had something to say, and her father was so happy that we paid the visit.

We next visited an old man called Mohammed who was a psychotic. He used to hear voices and go missing as he wandered the streets. He couldn’t see very well but he too was so grateful that we visited him and just listened to him. He now takes drugs which have stopped the voices in his head.

Both of these visits made me realise that some people don’t expect anything from you. We can't give them anything (we usually leave $5 or so, which always takes people by surprise), but it is often the first time anyone from outside their community has taken an interest in their illness. Just the fact that we come to listen is so important - I have never come across anything like it. Normally I would expect people to be asking "so what are you here for?" and "what are you going to do for me?" but you don't get any of that.

We set aside Wednesday as a training day for the Basic Needs team. As three partners with different areas of expertise and experience, we wanted to share some of our experiences with the Basic Needs people. We will run some more training sessions next week for some of the NGO partners that Basic Needs work with.

Jose-Luis ran a session on microfinance, Robbie talked about business planning, budgeting and project management, and I talked about… cultural diversity!

Before you start wondering how on earth I could be qualified to talk about this, when we were in Canada a few weeks ago we heard an excellent lecture from a chap from Amsterdam on the subject. In the afternoon Jose-Luis, Robbie, and I ran one-on-one coaching sessions with the Basic Needs team to help them deal with a particular issue that was facing them.

On Thursday we travelled further north to a city called Bolgotanga. This is the capital of the Upper East Region which has a population of about 100,000. This region borders Burkina Faso to the North and Togo to the East, and is the poorest in Ghana.

We met a number of the doctors and psychiatric nurses in the city to discuss the issues facing them – it appears transport is the biggest difficulty. The community psychiatric nurses often have to travel to very rural villages, but because they do not have their own motorbikes (the best way of crossing the difficult terrain) they have to hitchhike or ride on the back of commercial vehicles passing through the area. Unbelievable.

On Friday we travelled to two very small villages which were hosting more self-help groups. When I introduce myself, I stand up and say “Good morning, my name is Zubin and I have come from England”. I found out that this is translated into the equivalent of “his name is Zubin and he comes from the Land of the White Chiefs”!!! – referring to Great Britain as Ghana’s colonial rulers before independence!

Two individuals made an impression on me at these groups. The first was a man who was mentally ill but had originally visited a ‘Traditional Healer’. Some 95% of Ghanaians turn first to traditional medicine rather than ‘conventional’ doctors and nurses, and whilst many of the herbal remedies are no doubt effective, the treatment of the mentally ill is often very inhumane.

This man had his hands and legs chained together by a traditional healer, and was then beaten in order to rid him of the evil spirits which were making him ill. This type of treatment is not uncommon – I have heard a number of instances where the ill have been shackled and caned by traditional healers. It is very sad.

This woman had a child who was ill, and she really contributed to the group talking about the difficulties in raising a young son who needed so much care.

I think mentioned in my last update how much the children here in the rural areas are fascinated by us and love it when we take their picture and show them the screen on the camera. Here are a few pictures taken this week…

We had an amazing experience after one of the self-help groups on Friday. The group was gathered in the corner of a primary school playground, and when the kids came out to play they went straight over to us. We had a sea of little Ghanaian children around us, and when Robbie started to play ‘Simon Says’ with them they went absolutely crazy, pushing and shoving round us, jumping up and down and trying to hold our hands. I have never experienced anything like it! They then started chanting “So you are welcome! So you are welcome! So you are welcome!”. It was unreal.

I love the kid on the upper left of the picture who is clearly getting squashed by his friends in all the excitement!

When I talked about culture at the training session on Wednesday, I talked about one of the outer layers of culture being some of the first things an outsider to a country notices. There are so many things about Ghana that make me smile, but two in particular are the driving and the names of the shops.

On the way home from work the other day, Robbie and Jose-Luis spotted this guy. He wanted to take his sofa home from the shop, but instead of calling for a delivery lorry, he decided it was cheaper to use his friend who had a motorbike…! I don’t know if the picture will come out clearly enough, but there is a pillion rider balancing the sofa on his head!

One of the other things that makes me laugh are the names of the shops. So many comprise a religious reference plus the type of shop they are, so in the last week here is a selection of some of the names I have seen…

Thy Will Be Done Fashion Centre

Be A Man Clutch and Brakes

Stake Your Wealth Lottery

Great Provider Hair Salon

Except God Communication Centre

God Is My Defence Enterprises

Sanctuary of Glory Hair Salon

Think O God Enterprise

Amazing Grace Ventures

...any suggestions for what should precede “PricewaterhouseCoopers”?

There’s a north-south divide in Ghana too…

Note: on 4 July I couldn't post many pictures because the internet connection was very poor. I have now updated this bit - it is under the title 'how can a country so poor be so happy?'

We’ve been in Tamale in the Northern Region of Ghana for five days now and there are some clear differences with the south. It is poorer and more rural. From a mental health standpoint, care needs to be provided locally as there are no psychiatric hospitals in the region, and the road network is so poor that access from Tamale to the edges of the region can take a very long time. This means most mentally ill people’s first point of contact is with a traditional healer rather than a more ‘normal’ doctor or nurse.

Here’s a picture from a rooftop bar to give a flavour of what this city looks like:

In order to appreciate more fully the unique issues facing this region, we are continuing our tour of meeting people and organisations that work as partners with Basic Needs, and spending lots of time listening to their issues. To give you an idea as to who are these people, last Thursday and Friday we met...

* the head of the regional health service to understand some of the issues he faces. It is clear that getting access to some of the north-westerly areas of the country is very difficult – because of a river with no bridge crossing, 4WD cars need to head north out of the country into neighbouring Burkina Faso, before going west and south again back into Ghana!

* one of the very few nurses that specialise in psychiatric care

* an organisation that provides micro finance. This type of finance is a small interest free loan, typically around $40-80, that is lent to an individual to help them start a trade or grow crops. By getting the mentally ill back into employment, it reduces the burden they may place on their families, and this helps considerably in mitigating the stigma that surrounds the disease. Creating sustainable livelihoods for the mentally ill is one of BasicNeeds’ central themes.

* on Friday afternoon we met a very remarkable doctor:

Throughout his life he has been interested in the plight of the poor, and has dedicated himself to helping the poor who cannot help themselves (we is not interested in people who won’t help themselves).

In 1992 he started a clinic to provide free medical care to those in poverty, and since then has added a second. He does all of the operations himself (cataracts, amputations…), yet this is only a small part of his life. He organises free food for the homeless, and has a team of volunteers deliver it daily onto the streets. He provides all the prisoners and prison guards a Christmas lunch. And on Christmas day he organises a lunch for all the homeless, mentally ill, and poor people in the area – last year he had 3,000 people turn up at his house!

He was a very religious man, and when I asked him what drove him to do so much good, he explained that he made his hands available to God to do whatever God wished. Jose-Luis gave him the nickname of ‘Jesus’! I have never come across someone who got so much joy out of helping others. Here is a picture of all three of us together with some of the poor people who live at his house:

We spent the weekend at Mole (pronounced ‘Mole-ay’) National Park, which is Ghana’s largest national park. I have been on safaris in Kenya and South Africa, but they were in a Land Rover. On Saturday and Sunday morning we woke up early to go on a walking safari, which was great fun.

Here’s ‘DK’ our ranger and guide (the gun is not for show – they do fire it to scare the elephants if they start to charge!)…

We spotted an elephant that wandered onto a local community – here’s Jose-Luis either being super cool or not noticing what is behind him...

We also walked over to a watering hole where the elephants were cooling down. The black mounds in the background (in the middle of the water) are elephants. At one point I counted 15 of them.

Wherever you go, particularly in the rural areas, the kids come up to you and want to talk. They love seeing their picture on the digital camera – here are a few kids that stopped by at my balcony overlooking the game reserve.

When I went to pack up yesterday afternoon, I noticed that some of my underwear was missing. The park wardens did warn us about the baboons stealing stuff from balconies, so if anyone comes across a baboon in Ghana wearing some M&S boxer shorts, you can tell him he can keep them!

Many internet cafes do not equate to good internet availability…

It is now Thursday 6 July and I still haven’t been able to post the notes I have written for the past week. Everywhere seems to have an internet connection, yet none of them work when I’ve tried. Very frustrating. I just posted the last week's notes after trying so many internet cafes and Basic Needs' own network. I'm not sure how easy it will be to continue keeping this updated!
We returned from the long weekend at the Volta Dam on Monday (it was public holiday here) and spent the day on Tuesday with Lance who runs the Basic Needs operation in Ghana. We spent much of the day talking about what we have seen in the last week and what that means for our terms of reference.


The result was a marked-up engagement letter with our two objectives:

1. Developing a strategic plan for Basic Needs Ghana through to 2010. They wish to turn Ghana into a ‘West African Hub’ which covers other countries such as Nigeria, and we need to consider if/how this can be done.

2. The organisation drew up a Community Mental Health and Development plan in 2002 in conjunction with the Ghana Health Service. This is the approach that Basic Needs works in conjunction with the government to move mental health care provision closer to the community (rather than being solely served by Ghana’s three psychiatric hospitals). We need to revisit this, in conjunction with the government, to ensure it is relevant to new Mental Health legislation that will pass through parliament later this year. This can then be used in setting the agenda for the government, the donor community and non-governmental organisations (such as Basic Needs) on how best to provide care to the mentally ill in their communities.

Why are we doing this? It has become clear during our visit that mental illness encompasses a very wide spectrum of illnesses, from those who are schizophrenic, mentally retarded, epileptic, to those who are suffering from clinical depression or may be recovering from substance abuse. Earlier this week I read an amazing statistic: by 2020, mental illness will account for 15% of the global burden on disease, by which time depression will disable more people than AIDS, heart disease, traffic accidents and wars - combined. It is clearly a big issue which is not being addressed with the same priority as infectious diseases.

We have spent a week’s induction in Accra, the capital, so yesterday we started the next leg of our work when we flew up to Tamale, which is the main city in the Northern Region of Ghana.


This region is the largest by land mass, but also very rural. Tamale itself has seen troubles in recent times, following the beheading of Yakubu Andani II, a local traditional chief, in March 2002. Five of his sub-chiefs and 28 other family members were abducted by members of the rival Abudu clan, which resulted in local infighting. Tamale itself was subject to a curfew from midnight to 4am, but this has now been lifted.

We will be spending a couple of weeks in this region as the issues facing the mentally ill are very different from the south: because the region is poor, many areas are remote and have little road access, and there is no psychiatry hospital, the provision of mental health care has to be within the community by necessity. However, just getting to those communities is going to be a challenge. Next week we have a number of trips which involve long journeys in a Nissan Patrol 4WD over dirt roads just to get to some of the districts in the region. Time to charge the ipod…

Yesterday evening, after work, the Basic Needs team took us to see some traditional dancing and drumming. It was awesome – I’ve never been bothered with African dancing etc, but the energy of the drums was amazing. One of the guys said they do drumming lessons in the evening, so we may go there after work today. Robbie has professed himself to be an expert in African drumming, so we are going to take the lead from him!

How can a country so poor be so happy?

Note: this posting was originally without a number of pictures. I have now added them as of Monday 10 July.

Here are a few facts about Ghana, as sent to me in a text message by my friend James, a partner in Transaction Services:

* Ghana has a population of 21.1 million people
* Their life expectancy is an average of 57 years
* It has lost 79% of forests over the last century due to dependence on wood burning
* 78% of the population survive on less than $2 a day

Based on these facts, life in Ghana should be pretty miserable. Yet here are a few other facts:
* Ghanaians are apparently the second happiest nation on earth (don’t ask me who no 1 is)
* We have only experienced warmth from the locals
* Earlier in the week, when Ghana’s Black Stars played Brazil, Accra was in a state of frenzied excitement I have never seen before! For hours people were calling in to the chat shows on the radio saying they were going to win, with the clear consensus being 2-1, but in the end they lost 3-0. Even when they lost, people were happy and proud of their team.

This week has been a very busy week, which has meant no updates to the blog until today, Saturday. So here’s four day’s worth of updates.

Tuesday was a shock to the system: we visited a self-help group where mentally ill people get together within the community as a support network and are provided with drugs by Basic Needs that would otherwise have to be paid for (some drugs are not available free from the government). Robbie immediately took a shine to a kid with epilepsy:






























After this self-help group we visited two mentally ill people at their homes. We took the Land Rover into a very poor area, but everyone had football fever given the impending match, so clearly we had to join in…!

First was the kid and his older brother, both who had epilepsy. I have never seen such poverty: they lived with their mother (who had five kids, four by different fathers) in a ‘shack’ with three rooms, where a total of 20 people lived. Because they had not had access to community based mental health care, they had not been aware that there were drugs that could control the epilepsy, which meant they were excluded from school. Here are some pics:


This is their ‘house’ – if you could call it that. Note Robbie with his Ghana Black Stars hat!

Mother, younger son, older son

Their grandmother

Other family members – this kid was so affectionate towards his mum!


Jose-Luis found some football crazy kids – seconds after this one was taken, they started jumping and screaming in excitement underneath the Ghanaian flag!
Next visit was to a mother and her 32 year old mentally retarded daughter. The daughter could hear fine, but could not speak:

Her wrist was bent like that of a spastic. She was born healthy, but at the age of two had a convulsion during which she broke her wrist. Unfortunately this was never fixed, so now also lives with this physical disability.

The next visit was to an ‘outreach’ clinic. This is a community-based clinic that tries to provide care in the community itself (bringing the doctor to the locals rather than getting people to come to hospital). The doctors attend once a month, and it is also manned by a number of volunteers. The doctor we spoke to had been in since early in the morning and was trying to clear 80-90 patients before kick-off! We managed to get back in time for the game…

I love the look of the doctor - he was in mid-consultation with when Robbie walked in wearing his Ghana Black Stars hat!

Wednesday was a very different day. Ghana has three psychiatric hospitals, of which two are in Accra, the capital. We visited both, and each had a different atmosphere.

The morning was spent in Pantang Psychiatric Hospital. I can’t describe why, but it felt like something from Vietnam in the seventies. Maybe it was because it was all white, in an open space with lots of grass, very run down (it was built in the mid-70’s) and lots of barbed wire. Here’s a picture of the place:

The nurses took us round the chronic women’s ward which was for mentally ill patients in long term care. Some had been there for up to twenty years, and realistically had no hope of ever returning into the community:




The nurses were fantastic – the nurse in the left of this picture had been working at the hospital for much of her life, and she loved it, but pay was tough and last month didn’t receive any salary due to an administrative problem. She was so enthusiastic about her job and about teaching the two young nurses in the middle of the picture:

We met this woman who had been in the chronic ward for a year and a half. She came from Burkina Faso (border’s Ghana in the North), but neither Robbie nor me could understand what was wrong with her even though she spoke good English.

We passed the laundry area, so popped in. Ghana is hot and humid, but these women work in another level of heat and humidity! Jose-Luis asked them what they would like to make their job better – I expected them to say air conditioning, but they wanted a radio to listen to the football!

The next stop was to understand the occupational therapy department. This is to help the patients by giving them a task to help them on their road to recovery. For example, drug addicts in rehab often cannot concentrate for more than a couple of minutes, so they are taught to read in the library, whilst patients that struggle to integrate themselves with other patients spend time doing art with others.

We cut short our visit because of time, as the afternoon was spent at Accra Psychiatric Hospital. This is in the centre of Accra and was originally built 100 years ago as a lunatic asylum with high walls to keep the lunatics inside.

It was pretty run down, and the nurse who took us around said the hospital had not been paid by the government for three months.

First visit was to the children’s ward. This was very distressing for all three of us. Most of the children are so mentally handicapped that they will spend their lives in institutional care. The mentally retarded kid I am with in this picture had been living on the streets and was found at the hospital doorstep three weeks ago. He had apparently been very frightened of others when he first arrived, but was now getting more used to other people:


You could see the level of dedication from the nurses, but they had no resources. Many of the children had to wear nappies, but had to make do with donated rags instead.



Next was the geriatric women’s ward. I spoke to a few who could speak English, and received lots of prayers from them.



We then visited the main wards – women and men. These each have 150 patients in a ward, with not enough beds so some have to sleep on the floor. I didn’t take pictures in the women’s compound as some wore no clothes (and I’m not sure they were even aware of this fact).

The men’s compound was originally pretty intimidating – the security gate opens and you enter a compound with 150 mentally ill men of all ages. Very quickly we were made to feel very welcome. Many of the patients were suffering from schizophrenia, or recovering drug addicts. We entered just as they were getting their evening meal.


We all spoke to many patients and had some bizarre conversations:
“What do you do?”
Me: “I help companies in trouble”
“But what is your profession”
Me: “I am an accountant”
“That is excellent, you can work for me in my international company. When can you start!”


Another one was:
“Where do you come from?”
Me: “Where do you think”
“You look very Chinese to me” !!!!
- I have been called many things, but never has anyone said I look Chinese!

Next day was a visit to another self-help group. It is interesting hearing what people’s concerns are: when Humphrey from Basic Needs talked about a small amount of funds being available for the community to fund drugs, one man asked for it to be allocated to him and deposited in an account in his name at Barclays Bank!

We then visited the home of a 21 year old boy called Kwesi. He had been born prematurely, and had oxygen starvation to the brain, resulting in him being mentally retarded since birth. He could not move the right side of his body. His father was a very strong man who had taken so much care of him, with very little money. His biggest concern was what would happen to Kwesi when he and his wife eventually passed away.

It was interesting to hear how the stigma of mental illness affects a family. Kwesi’s mother tried to earn an income selling bottled water, but had been shunned by much of their community who thought Kwesi was a witch, and the water his mother sold would be infected. Basic Needs provided Kwesi with free drugs to control his convulsions.

We moved on to a 23 year old called Seth who has had epilepsy since the age of one.

My ability to ask compassionate questions flew out of the window with my opening question as I sat down in his sitting room and asked “so what it wrong with you then?”. What a plonker! I felt so stupid!

Luckily the atmosphere relaxed and I asked him about the impact his epilepsy had on his life. He no longer goes out of the house and had dropped out of college. Basic Needs provided him with free drugs to control the epilepsy which meant his last fit was over two months ago,

Taking us round was a Community Psychiatric Nurse (CPN) called Agnes. She was fantastic, and really knew her patients and cared for them. I met her on the following day and she said she was a year from retirement. All she wanted to do when she was a child was to be a nurse, and said she had loved her career.

Friday was a short day because two meetings with district heads of clinics were cancelled, but we went ahead with the third. The doctor was a real character who had trained in the Soviet Union and had some great stories to tell.

This has been a long weekend with a public holiday on Monday, so we have travelled east to the Volta Dam. This was built in the 1960’s and is the largest man made lake in the world – from memory it is 400km long and has a coastline of some 5,000km. We stayed at the Volta Hotel that overlooks the dam and on Sunday took a cruise around the lake.





On Saturday night we met a band who were playing at our hotel. One of the singers called Leslie asked our names – because we had just watched France beat Brazil, Robbie introduced Jose-Luis as ‘Ronaldo’. Bad move – for the entire set, Leslie was shouting out “Ronaldo!”, to the point where on Sunday morning, a hotel guest came up to Jose-Luis, called him ‘Ronaldo’ and said he was sorry his team were out of the World Cup!!!

Back to Accra on Monday night to our apartment. Here’s a picture from the front of our place. Reminds me a bit of Mogadishu, Somalia, in the film ‘Black Hawk Down’…


In all it has been an exciting week but also hard work – I’ve found the heat and humidity gets to you by mid-afternoon, which means it is difficult to concentrate in meetings with hospitals. It has also been a shock to the system, seeing such poverty and suffering, particularly among those who have been rejected by society because of their mental illness.

The week was meant to be an induction into the issues facing Basic Needs, and it has certainly given us a flavour of what we may face over the next two months. Sometimes the scale of what needs to be done feels daunting, but also very exciting!

This week we travel up to Tamale, Ghana’s second largest city in the north of the country, to see what issues face the Northern Region. I’ll also try not to leave it so long to update the blog…