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”!