Deadlines are the same wherever you are – the pressure mounts!

We are now approaching the conclusion of our work, and have two deadlines looming.

The first is next Tuesday when we are facilitating a workshop with a number of agencies that have an interest in improving care for the mentally ill. Attendees will come from a wide variety of organisations such as the Ghana Health Service, World Health Organisation, World Bank and a number of donor agencies including foreign embassies that have development funds available.

The purpose of this workshop is to refocus the debate on the critical areas facing the mentally ill and discuss how they may be addressed. We will explain what we have seen – and this is particularly important given we are completely impartial, which I will elaborate on later – and then discuss how the draft legislation is a good starting point but it can never address all of the issues (such as ending social marginalisation of the mentally ill), before outlining our view of an all-encompassing Community Mental Health & Development plan for the country. Whilst in the developed world it is the government which usually will formulate its social policies, it is very clear that here in Ghana, as a developing country, there are many outside agencies (such as NGOs like Basic Needs) which have a significant input into the debate, and that is what we are doing here.

The second deadline is on Wednesday when we are facilitating an internal workshop for Basic Needs to reflect on where it has come from in Ghana over the last four years, looking at what has and has not worked well, and then look forward over the next five years as to where it should focus its efforts. Our work has highlighted a number of fundamental issues that need to be debated if the organisation is to be as effective as possible going forward. None of this is rocket science, just basic questions surrounding issues such as:

* developing a broad and long term donor base (you would not invest all of your savings in just one company, or buy a house with a bank overdraft);

* trying to meet the career ambitions of individuals and considering succession planning; and

* agreeing priorities such as whether to consolidate before expanding further.

Back to the job in hand, and that has meant we have been on the road meeting people. Here we are outside our apartment which we call Mogadishu… The area really is run down and a mess, but then again, this is Africa!

On Tuesday we had a meeting with the Minister of Health, who is in the cabinet and reports to Ghana’s President. He is the one on my right in the light blue short sleeved shirt.



He was originally a soldier and, I believe, was involved in one of the country’s military coups in the 1970’s, but since then has been Minister for Agriculture, (I think) Minister for Roads and is now Minister for Health. It was an interesting meeting, because when we explained who we are and what we were doing, he became very engaged. He said that because we were independent and not from the medical profession, we had no vested interest, job or budget to protect, and that meant we could truly be impartial – whatever we said would have no consequences on our job or lives back home. He wanted us to be totally frank about the weaknesses and challenges that we saw and what we thought should be done, because he often heard his own people only emphasise the positives and their successes rather than the problems.

We took him through our views and he agreed that mental health was an important issue which may have been sidelined for too long. Whilst actions speak louder than words, and whether anything happens about it is another matter, what is clear is that this was only the second time Basic Needs had engaged with the Minister and it is important to continue the dialogue with both himself and his department, as inevitably one needs to say the message many times before it is truly heard and understood.

That afternoon we paid a visit to the local PwC office in Accra. I had been speaking with Felix, the Advisory and BRS Partner, for some weeks but because we spent most of our time in the North of the country we had not had a chance to meet.




The two others in the picture work on the local audit of Basic Needs, so it was very useful to make contact with them and explain what we were doing. They have helped put us in touch with someone who may be able to help the organisation identify donor funding.

Wednesday was a day of solid work. Our apartment is too small to work in, and the Basic Needs team were all busy, so we decamped to a hotel and got down to it. We have all worked together on this programme so far, but given the looming deadlines we split the work up between us, which meant that by the evening we had completed most of the material for the workshops next week.


We used Thursday to take Lance, the Ghana Country Manager, through our work from the day before. Because none of us have worked in mental health before, or in an NGO, we have looked at Basic Needs in Ghana with fresh eyes. It was obvious from our discussions with Lance that we saw the organisation with a different perspective. He was so pleased, and commented that we had brought a clarity to challenge ahead that he had been struggling with himself, particularly in relation to the immediate priorities.

Later in the day we did an interview with a journalist from the Daily Graphic, Ghana’s main newspaper (he’s the one in the middle).

We talked about the Ulysses programme and what we had been doing, but also focused on the main message we wanted to get across: that the government needed to place an increasing priority in caring for the mentally ill, as to do otherwise would have adverse economic, social and moral consequences. The journalist has been following Basic Needs for some time and was both personally interested in the subject and well-informed, which is encouraging.

A few more pictures from the last week. Here’s another training day we ran for the Basic Needs Accra team. Unfortunately the turnout was low because of some last minute drop-outs (sounds suspiciously like a PwC training day…)

And here’s a picture of us with some of the Accra team:


Last week we did some work at Ankuful Psychiatric Hospital, which is on the south west coast. We stayed in the area over the weekend, and paid a visit to Cape Coast Castle.


This is a truly shameful part of Britain’s history. It was built in 1653 but captured by Britain in 1665 where it became the heart of the slave trade. Slaves were captured throughout West Africa, and were brought to the Castle where they held in dungeons before being shipped to Europe. The conditions on the five week boat trip were so cramped and unhygienic that it was apparently not unusual for a boat to lose half of its human cargo on a voyage. Between the late 17th century and the early 19th, when the slave trade largely ceased, it is estimated that between12-20 million Africans were sold and exported as slaves.


Entering the darkness of the dungeons was not a pleasant experience. There were no sanitary facilities, and 600-1000 slaves were held in three rooms each no bigger than a typical large hotel room. Any that tried to escape or proved difficult would be placed in a cell without food or water where they would usually die in two to three days.

The Castle gave us a great view of Cape Coast town, where we saw both of the fishermen as they worked on their boats and nets…


… and the slum, mess and poverty that characterises so much of this country.


Finally a picture of us in a national park earlier in the day…


… and another taxi driver who writes messages of inspiration to himself.


(If the picture doesn’t come out very well, he was written “Still… Good Boy” – clearly someone who doesn’t want others to think he has become a naughty boy!)

We had a visitor!

At the end of last week we travelled from Kumasi in the Ashanti Region back down to our base in Accra, and yesterday we then moved west to work in Cape Coast, which I will talk about later.





The reason for returning back to Accra was that last Sunday we were joined by Lisa from the Ulysses team. Lisa is our team coach, and she came out to work with us ensure we are making the most of the learning opportunities that this programme provides. Here is a picture of us after dinner:



This is principally a partner leadership development programme, which means that although we are working for Basic Needs and trying to help them, we are also using this experience to work on our own personal development. Lisa’s job is to ensure that we strike the right balance between what we do for Basic Needs and what we achieve for ourselves, and therefore, PwC. I reminded myself about something I had read some months ago about why the firm runs this programme: if the future of the firm is going to see more, and not less, work across borders, across cultures and considering a broader range of issues (which increasingly include the social and environmental impact of what we do), you cannot just learn this in a classroom. We are doing this by changing our environment from our day-to-day world in the office, and therefore this involves changing the country, the work involving mental illness, working with a non-governmental organisation (rather than a commercial business), and living with extreme poverty at our doorstep. The environment is changed further by bringing three partners from opposite sides of the world together, where we have to live and work together for almost 2½ months with minimal contact with our families and friends.

If this sounds like a recipe for disaster, I am sure there have been Ulysses teams in the past that could not stand each other by the end of the programme, but so far the three of us are getting on very well. Lisa’s challenge to us, both individually and as a team, is to maximise the learning over the remainder of the trip and to think about how we take what we have learned back to the office.

To help Lisa understand what we have been up to, we took her to Accra Psychiatric Hospital and also on a visit to the homes of some mentally ill people living in the community. We first went to meet a woman called ‘Billykiss’ (I can’t believe that is her real name!) who suffered from panic attacks and depression. She is the woman on the left:



She was living in a rented room in a dreadful slum in Accra, where life is very tough: no running water, shared toilet, open sewers. She sold drinks at the side of the road, which meant when the weather was poor, her money dried up. As a mentally ill person, she suffers the same stigma in her community that I have talked about before, which meant that one time when she was late with her rent, her landlord attacked her. She showed us this picture, which I took a photo of (so it is poor quality), but you can make out the blood covering her clothes:



We then moved on through the slums, crossing a bridge over the open sewer and a rubbish dump. The bridge was a bit wobbly and slippery – I’m just glad we got across ok!



And another picture of the conditions in which people live – here is a path between the houses littered with rubbish and water from the recent rain.



We arrived at the house of two epileptic young men (one was my age – so he is still young!). One used to suffer four fits in a day, one had up to seven fits a day. During an epileptic fit, part of the brain is damaged, so you can imagine the impact this has on their condition.



Although we were in a very poor area, people still take so much pride in how they look and dress. Here is the mother of one of the men, together with a community worker and another epileptic, as they listen to the stories of the two men.



After Lisa left on Wednesday evening, we travelled west on Thursday to Cape Coast. This is the home of Ghana’s third psychiatric hospital called Ankaful.



We had arranged a meeting with one of the doctors, but when we arrived it turned out there had been a mix up and he was on leave! Nevertheless we went round the hospital and went to some of wards. When we were there the hospital had 312 patients, despite its capacity of around 250. Those who didn’t have a bed slept on foam mattresses. Those who did not get a mattress simply had to sleep on a mat on the floor. It was very useful comparing Ankaful with the two other psychiatric hospitals that we have visited (Accra and Pantang), and we spent much of our time explaining to the staff what Basic Needs does and how it works with the mentally ill in the community, rather than in a large mental institution, as is the case with Ankaful. It was also the first time we were shown electro-convulsive therapy. This is given as a last resort (and is governed by law) as a way of helping those who suffer from chronic depression or schizophrenia, and involves delivering electric shocks to the brain. Very scary…

Finally, as ever on our travels, we continue to see things which make me laugh. I cannot get over the number of lorries that are broken down by the side of the road (although we experienced this earlier in the week when someone filled diesel into our petrol car…). Preventative maintenance seems to have escaped many Ghanaian lorry drivers, although if they didn’t overfill their trucks I’m sure it would help – this one was carrying coal, although I'm not sure for how much longer:



And quote of the week goes to the driver of this tro-tro (they are the local busses) who seems to be exhibiting mild schizophrenia himself given the way he is talking to himself...



Next week we are back in Accra preparing for our final workshop – more in the next blog.

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”?