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Unavailable and underfunded: mental healthcare in Ghana

The Accra Psychiatric Hospital only has a capacity for 600-800 patients, but currently houses many more.

Like much of the developing world, mental healthcare is lacking in Ghana. Mental illnesses are deeply stigmatized and widely misunderstood, and access to mental health professionals and infrastructure is limited. Although the recent passing of the innovative Mental Health Bill lays the legal framework for the required changes, steep challenges remain.

Ghana spends 2.58 per cent of an already small health budget on mental health. Accordingly, Ghana has only three publically-funded mental health hospitals. The hospitals are all old, overcrowded, and located in the southern part of the country. Consequently, they fail to provide adequate care for the estimated 250,000 people that need treatment in the country.

Pantang Hospital, the newest in the country, was built in 1975 and is located just outside Accra. Ankaful Hospital was built in 1965 and is located in Cape Coast, 150 km outside Accra. The largest hospital, the Accra Psychiatric Hospital, was built in 1906 and is located in the centre of the capital. It only has a capacity for 600-800 patients, but currently houses close to 1,000. It’s a condition that “compromises the comfort and general well-being of patients and constitutes an appreciable strain on [the hospital’s] resources, staff and funds,” according to the hospital’s website.

There are also only twelve psychiatrists working within the government system, many of which perform only administrative duties. There are fewer than 500 psychiatric nurses, more than half of which are located in the mental hospitals, leaving the rest of Ghana wanting.

The result of the widely unavailable care is that many rely on traditional healers, especially in the more rural and impoverished northern parts of the country. Their methods vary from prayers to exorcisms to human rights abuses.

“We’ve seen people who have cuts on their bodies that have festered into sores… It’s all under the guise of treatment,” said Peter Yaro, the Executive Director of BasicNeeds Ghana, an NGO that seeks to “ensure people with mental illnesses and their families live and work successfully in their communities,” according to Yaro.

“We have seen people who are shackled and left in the open, rain or shine for days. We’ve seen people who have been locked in rooms for days, months, and years. They ease themselves there, they eat there, and they sleep there. And nobody bothers to do anything about it until it’s reported to us,” he added.

The garden inside the Accra Psychiatric Hospital.

BasicNeeds has been operating in Ghana since 2002 and has since expanded to six out of Ghana’s ten regions. It strives to improve access to appropriate treatment, teach people with mental health conditions to support themselves, give people suffering from mental illness a political voice, and address the fiend that exacerbates all mental health problems in Ghana – the monstrous social stigma that surrounds the issue.

In Ghana, people with mental health issues are widely misunderstood and mistreated. People view mental illness as anything from a deserved consequence of a spiritual transgression to a contagious condition that will infect anyone who works in the field. As a result, they are discriminated against and marginalized, Yaro explained.

“The moment you are seen as mentally ill you are seen to be less human.… People think you can’t even feel,” he said. There is also little understanding of, or interest in, proper treatment.

“For those who know about the hospitals, they come and dump you there. For those who don’t know about the hospitals, they dump you at the traditional healer so they can move on with their life,” Yaro said.

The social stigma also affects the professionals who work in the field. Unlike other medical specialties, psychiatry is not prestigious. “It’s not attractive. It has no status, socially,” said Yaro. Because of this, and the fact that many people still think mental illness is contagious, few choose careers in the field.

The Mental Health Bill – the government’s plan to address these pressing issues – was finally passed on March 2, 2012. Originally drafted with help from the World Health Organization, the Bill meandered through parliament for eight years.

It emphasizes community based treatment over institutionalization. This is very important because up until the Bill was passed, the legislation that guided Ghana’s mental health service plan had changed little since the colonial Lunatic Asylum Ordinance made in 1888, explained Yaro.

“The national health policy under which mental health services are provided is not only arcane, but very bad,” he said. “We’ve come a long way towards understanding what mental health issues are and the law needs to be retrofitted.”

The Bill also introduces regulations for both public and private care providers need to adhere to, legally protecting patients’ rights. It also calls for a decentralization of care centers and and seeks to battle the stigma through public education campaigns.

It is estimated that more than 250,000 people in Ghana need psychiatric treatment.

The passing of the Bill marked the ratification of the UN Convention on the Rights of Persons with Disabilities. Ghana was one of the original 80 countries to sign the convention in 2007 and activists and mental health care professionals eagerly awaited its ratification since.

“I don’t know how to express my joy. Eight years of anxiety, apprehension and patience- that is how I can describe my feeling now. If we knew that the bill would be passed today, we would have come here with buses full of people and thereafter paraded through the streets of Accra to exhibit our joy and appreciation,” said Dr Akwasi Osei, the Chief Psychiatrist of the Ghana Health Service, at the time of the Bill’s passing.

“The way the Bill is drafted means a revolution,” said Yaro. Although the Bill received Presidential Assent on June 8 and became law, the revolution is still coming.

The massive investment required for the full implementation of what is in the Bill seems unlikely in the near future. Ghana is a Lower-Middle Income country and its economy is largely dependent on foreign aid, which makes up 11.7 per cent of the country’s GDP, according to the Organization for Economic Co-operation and Development. Its public health care system battles both corruption and a “chronic shortage of funding,” according to a 2008 Austrian Centre for Country of Origin and Asylum Research and Documentation (ACCORD) report.

“We have to be optimistic, however one should not lose sight of the [challenges],” said Yaro. In the meantime he is happy with the progress made so far and will continue working with BasicNeeds as Ghana moves forward with its mental healthcare policy.

Repatriating Ghana’s “Witches”

Ghanaian witch camps are a cultural phenomenon I have yet to fully experience and understand. Although I have read much about them and spoken to some people affected by accusations of witchcraft, I can only conjure a vague image of what it must be like to be banished from one’s village to live in poverty and severe segregation.

Witch camps are mainly located in the northern regions of the country, where belief in witches and the supernatural is generally much stronger than among the more cosmopolitan, urban areas along the coast.

All it takes is one accusation from a disgruntled, superstitious, or envious neighbour or relative to tarnish a reputation and drive out even the most well-respected women from a community.

Forced Out

These women, who typically leave their homes with no possessions, tend to gather together in camps where they eke out a living any way they can. The small economic and social communities they form become the infamous “witch camps” where they remain disempowered, and embody the gender disparity in Ghana.

“Anybody could be a victim,” says Hajia Boya Hawa Gariba, the deputy minister of Women and Children’s Affairs.

That’s why the Ministry is seeking to peacefully disband all of Ghana’s six witch camps over the next three years, she said, speaking with me in a phone interview that aired on Pravda Radio.

The Ministry has recently commissioned a task force involving the Commission on Human Rights and Administrative Justice (CHRAJ), the domestic violence unit of the Ghana Police Service (GPS), the Department of Social Welfare, and the NGOs Action Aid Ghana and the Presby GO HOME Project, she said.

The goal is to repatriate and reintegrate the ostracized “witches” back to their homes and into society. Gariba says the root cause of banishment of witches is cultural beliefs “that have no place in society.”

Open Arms

In order for the women to return safely to their homes, the task force will be educating their communities on basic human rights, the law, and domestic violence. Educators have already been taking the families to the witch camps to show them how the women are living, and discussing the rationality of the beliefs.

For example, Gariba explains, accused witches are made to drink a concoction that is said to take away their power before they are banished. She argues it is against a person’s human rights to make them consume a questionable, and potentially harmful, substance against their will.

Despite consuming the drink, the women are still forced to leave, which makes no sense, according to Gariba, since the witch’s powers are supposed to be neutralized.

Educating communities has been making some gains in the reintegration process, and Gariba says the women’s security is the ministry’s primary concern. She says they also intend to make the women comfortable enough in the camps so that they do not die from exposure, but not enough so that they will not want to go back home.

“These people are human beings. There’s no point in leaving them there.”

Malaria, the hospital, and Ghanaian health care

At the Labadi Polyclinic in Accra, the queue for insured patients is empty. The vast majority of Ghanaians still pay for their medical care “out-of-pocket.”

There is an odd fear and fascination with Malaria in Canada. To many, it’s an “exotic” and deadly disease. It’s shrouded in misinformation and myth. Travelling to a high risk zone, I fecklessly stocked up on mosquito spray and prophylaxes.

After only two weeks in Ghana, I developed a hellish fever. In a haze, I wandered a few blocks to a small hospital. I was too zoned out to figure out my travel health insurance, so I walked past the line for “insured” patients and joined the much longer line for the “uninsured.” I was diagnosed within a couple hours, immediately treated, and, within 24 hours, felt significantly better.

For me, and anyone else who has easy access to proper treatment, Malaria really isn’t that big of a deal. Amazingly, however, Malaria continues to kill more Ghanaians than any other disease.

The idea for the National Health Insurance Scheme (NHIS) first surfaced as a campaign promise in the 2000, in order to improve access to basic health care services and eliminate the widespread “out-of-pocket” payment for health services. The idea became law in August of 2003, and, in December 2004, the NHIS was established.

Since then, the NHIS has always been on the political radar. In 2009, President Atta Mills and the National Democratic Congress vowed to improve the struggling system, striving to make publically funded basic health care universally available.

The idea is that Ghanaians contribute to a fund so that they are financially supported when they need medical care. Formal workers pay a percentage of their income to the system and informal workers- about 80 per cent of the Ghanaian workforce- pay a flat rate to the NHIS. In return, they qualify to have their basic medical expenses covered by  NHIS. In practice, however, things are quite different.

“The concept is good, but the reality isn’t. It doesn’t really help many people,” one Ghanaian friend told me.

In 2008, there were only 1,500 health care facilities to service the entire Ghanaian population of 24 million people. According to a 2008 Austrian Centre for Country of Origin and Asylum Research and Documentation (ACCORD) report, these facilities are not evenly distributed and the average Ghanaian lives about 16km from a health care centre.

Plagued by chronic funding and personnel shortages, the NHIS doesn’t cover the very people it was designed to serve.

On May 2007, the NHIS covered under half of its targeted people. That’s only 19-65 per cent of the population, depending on the region, said the same ACCORD report.

OXFAM estimates the numbers to be even lower – around 18 per cent. The same 2011 report maintains that most people covered are rich, not the poor who the system was designed to protect from the high user fees.

Whatever the numbers may be, the reality is that most health care spending Ghana continues to be “out-of-pocket.” In 2005, out-of-pocket expenditures amounted for over 65 per cent of all spending on health care, according to the ACCORD report.

The “out-of-pocket” expenditures are not cheap. For my visit, I paid one cedi for my file, eight for my consulting fee, 15 for the blood test, and 10 for the treatment. For me, the total cost was 34 cedis, about $18 USD. The minimum wage in Ghana is only 4.48 cedis per day, about $2.66.

Due to the high cost associated with health care, and the failure of the NHIS to offset this cost, many Ghanaians seek traditional treatments or self medicate. That means people aren’t going to get the same quick, effective malaria treatment I was privileged to: the reason why a curable disease is, sadly, the disease that claims the highest number of victims in the country.

Children walking from school

The drive to protect Ghana’s youth

Two schoolchildren start their walk home down Secondi Road in Takoradi, Ghana. Photo by Alyssa McDonald

 

 

Francis Donkoh waited on the meridian while a police officer stopped a busy street full of afternoon traffic for him to cross the zebra crosswalk. He was walking home from school with with a group of friends, including his sister Anne Marie and cousin Melissa.

It was then that a vehicle leapt onto the meridian and crushed eight-year-old Francis, taking his life.

Road accidents kill and injure more children in Ghana than disease and conflict combined. It kills more children than diseases like malaria and HIV/AIDS worldwide. It is an epidemic. According to the World Health Organization (WHO), injuries caused by road traffic are the leading cause of death worldwide among youth aged 10 to 24 years old.

On January 21, 2011, Chris and Fanny Donkoh heard a commotion outside of the house they share with their extended family and went to investigate.

“As a young couple, we didn’t expect for this to happen to us,” Chris said.

Chris and Fanny Donkoh in their house in Takoradi. Photo by Raquel Fletcher.

He walked no more than 20 meters before realizing it was his children lying on the road in front of him. Fanny was right behind.

“When I got to the accident site, everyone who knew us… everyone who had seen what had happened… they were just looking at me,” Fanny said, recalling the day of the accident. “I went over to the scene and saw Francis was in Chris’ hands, dead.”

Fanny was brought back to their compound which they share with Chris’ parents and brother’s family, while Chris stayed with his son’s dead body. At this point,  they had not heard news of their daughter Anne Marie and niece Melissa. With rumours starting to circulate that the girls had died, Chris went to the hospital.

“Anne Marie was there and alive but she was still recovering from the shock,” Chris said.

Someone who had seen the accident helped Anne Marie and Melissa get to the hospital. Knowing an ambulance would take too long, they tried to convince a taxi to take the girls for help. Numerous taxis refused to take the them because they were bleeding so much. They resorted to a tro-tro, a long public mini-bus to take the girls to the hospital. The Donkoh’s say they still are unsure of who this good Samaritan is.

Anne Marie with the Donkoh's youngest son Antonio. Photo by Raquel Fletcher.

Thirteen-year-old Anne Marie walked away from the accident with non-life threatening injuries and remained in hospital for three months. Melissa was flown to a military hospital in Accra, Ghana’s capital city, but died a few days later. As far as the Donkohs know, Anne Marie is the only surviving child of this traffic accident.

The Donkohs decided to take action by founding the Francis Donkoh Memorial Road Safety Foundation. “We want to spread awareness to youth to save our future leaders,” Fanny said about the foundation in Francis memory.

According to Chris, the foundations main message is “if you are not trained to drive, please for heaven sakes, do not drive.”

Their voice joins other awareness campaigns about the importance of road safety. The WHO and United Nations have named the next ten years the ‘Decade of Action for Road Safety’, spanning from 2011-2020. They have started the Make Roads Safe campaign, which reaches out to countries all over the world, but specifically to developing countries where 90 per cent of these deadly crashes occur.

Ghana’s National Road Safety Commission (NRSC) has already started making changes to their educational programs under the campaign. Along with their traditional school visits, they are also talking to Parent Teacher Associations (PTA), holding community outreach nights and advocating for road safety to be put into primary school curriculums.

Henry Asomani, NRSC Western Region planning officer, said 23 per cent of all pedestrian fatalities in Ghana involve children below the age of 16 years, most happen while children are walking to or home from school.

“We are visiting [PTA] meetings and telling them, ‘Please don’t allow your children to cross busy roads. If possible, take them to school, if you can’t, let an adult bring them to school,’” Asomani said.

Chris now drives Anne Marie to and from school every single day. He said this is not just for her safety but she finds it difficult to forget the accident. “Every time Anne Marie gets to the junction, naturally she just remembers the moment of the vehicle, speeding off. Its not easy,” Chris said.

The family has remained in their house and therefore is close to the memories of that day. “Where we stay, right where the incident happened, the memories will forever be there,” Fanny said. “Anytime we go outside, to go to work or to church or wherever… you still have to recall what happened on that day.”

A road safety billboard in Northern Ghana. Photo by Alyssa McDonald.

The crash that killed Francis and Melissa was caused by one large truck not recognizing all the other vehicles were stopping to allow the children to cross. The vehicle kept going full-speed and pushed the vehicle in front of him onto the meridian, which trampled the children waiting to cross the street. A total of six people were hit, including Francis, Melissa, two school friends and a grandmother walking her grandchild home from school.

The man who caused the accident ran away from the scene. The truck was traced back to his employer who told the Ghana Police’s Motor Traffic and Transport Unit (MTTU) the identity of the man who was driving the truck.

Chris and Fanny say the driver was arrested, went to court and has since been released out on bail. They chose to not go to the courts

“I am not really sure who killed our children, whether he was a liscened driver or not. But I don’t want to know that,” said Chris. “We don’t know his fate, but whatever happens to him does not bring my son back. That is our mentality now.“

The Western Region MTTU says they will charge those who they believe cupable for road accidents. The top reasons for the crashes are speed, inexperience, alcohol, and bad road conditions. Takoradi used to be a quiet city but with the recent oil dicovery has changed it into an ‘oil city’. There are now workers coming in daily with tankers, large truck and all other automobiles. The falling down city now has traffic jams that clog residental streets.

The crosswalk where Francis died. Photo by Alyssa McDonald

The road where Francis was killed is one of the busiest in Takoradi, it connects suburbs like Airport Ridge to the main market circle. The Donkoh’s home is the second compound off the street in Airport Ridge, one of the most expensive areas in the city.

Although Ghana has the fastest growing economy in the world according to Economy Watch, its infrastructure does not meet its economy. Many of the roads have potholes that make traffic slow to a crawl. This combined with unlicensed drivers and no control of alcohol consumption makes for a deadly combination.

When I was traveling in Ghana, we would drive quickly down the windy roads that cover the countryside. There were always families walking or children selling goods on the shoulder. On more than one occasion I looked over to see how fast the vehicle was going only to see the speedometer was broken.

Most people travel in a tro-tro, Ghana’s most widely used form of transportation that holds upwards of 15 people. If the tro were to crash, the 15 people in the aboard’s fate would not be a happy one. All, including myself, were not wearing seatbelts and small children sitting on the laps of their mothers.

The highways in Ghana are undivided and take steep turns. Every 15 kilometres or so, a red Toyota sign appears at the side of the road which says ‘Overspeeding Kills. ‘x’ number of people died here last year’. I saw the ‘x’ range from four to thirty.

The NRSC teaches children how to protect themselves from car accidents. Indira Apronto, head educator at the NRSC, goes to Ghana’s Western Region schools to teach children how to walk or play near roads. In the classroom, she asks them to show her how they walk by the roads and then the class acts out scenarios where cars would veer at them. This is how children are taught to protect themselves.

Melissa (left) and Francis (right) graves in the Takoradi Cemetery. Photo by Raquel Fletcher.

“They admit that they do some of the wrong things and then we talk about it,” Apronto said. “We follow up and we get to know that they are changing their route. It takes some time to change behavior, but they do change.”

NRSC teach them the school children lessons like always walk on the outside of a parent or adult. Then, if a car does veer at them, the adult is more likely to get hit than the child. Although this may sound horrifying to most Canadians, this is what Ghanaians have resorted to in order to save their children.

Every time a child is hit, their right to education, to play, and to live is in jeopardy. Mothers like Fanny have lost their child forever and will never forget.

“Definitely with this experience, there will be that kind of… missing your son, day in and day out,” she said.

IMG_9536

Meet the Tognis: Las familia Circo

Yecid’s clothes don’t fit him quite right, his shoes are four sizes too large, his left wrist sometimes pops out of place and it always aches with arthritis. The mangled joint is a painful reminder of a fall he suffered at work. At the same job he’s had more than forty years, where every night his employer beats him and a gathered crowd of spectators applaud his humiliation.

This may seem exploitative, but Yecid has passion for a craft he hopes others find silly. He’s a clown in the Darix Togni Italian National Circus. His employer is the tiger-tamer and both say the Circus is more than work, it is a culture, a family and a lifestyle they will perpetuate.

“When you are born into it (the circus). It is a part of you, it’s in your blood,” Yecid says. He sits on a concrete park bench between two temporary alligator ponds. He’s forty-five and at this point has done every job under the big top. In addition to clown duties he is also the crew’s chief animal wrangler and makes nightly cameos with the trapeze act. “The circus gives me joy, I live for the adventure.”

 This clown’s nomadic path began at birth in a caravan in Venezuela. His father was a trapeze artist and his mother dazzled audiences with graceful precision on the aerial silks (aka ribbon trapeze). “Her performance was the most beautiful,” he says, pausing a moment to wipe nostalgic tears from his face. “All eyes in the crowd were on her. It inspired me.”

As a toddler, he takes his first steps into the performance ring. The act is child- clown, but by five he is on the trapeze and in his teens he is seen on television screens across South America.

“I became famous, people in the streets of towns I’d never walked knew my name.” Yecid’s performance is an rigorous display of refined acrobatics executed above the heads of frenzied fans. During one of these spectacles his hand slips. Momentum carries him outside the net while gravity brings him down with force. He attempts to break his fall but his left arm shatters on impact. The accident leaves him with broken ribs, bruises and an arm no longer capable of strenuous trapeze maneuvers.

The last moments before showtime are critical. Backstage is an open-air yard fortified by strategically placed shipping containers, fences and temporary animal enclosures where five tigers, two alligators and one kangaroo watch the performer’s final preparations. A group of men converse in Spanish and Italian. They spin wrenches, tell jokes and fine tune the motorcycles used in the “Globe of death” act. Circo showgirls Astrid, Alessandra and Alissa plume their head-dresses while others gather around an octagonal pedestal beneath a canopy. Vera, a Brazilian acrobat, goes through a yogic stretch routine while Mongolian contortionists Inga and Tsatsral apply shimmered eye make-up to their faces.

Martina, a blonde Italian clown, and Ali, the resident mystic, sit on the edge of the octagon. The pair are already painted and take a few moments to entertain a baby while the child’s parents prepare. The infant is the seventh generation of Togni to travel with the circus. His parents are Francisco, the strong man, and Elis Togni, the solo trapeze artist.

“It’s an extended family,” says Elis, in a pleasant maternal voice. “We look out for each other, help each other.” She scans the group of artists gathered before her, “I know if I need help with the baby they are here. And they know they are safe and protected. If an outsider caused a problem it would be handled.”

The family patriarch is tiger-tamer and master of ceremonies Davio Togni. He and his brother Livio, a former Italian National Senator, keep a watchful eye over the circus and its naturalized offspring. This family tradition descends from a legendary Italian performer.

“In Milan, Darix Togni is synonymous with Circus,” says trapeze artist Daniel Togni, while reviewing the playlist for the night’s performance. He is the son of Davio, brother of Elis and heir apparent. “Darix was the first man in Italy to master the art of animal taming.” Daniel never met his famous ancestor, but the family moniker has defined much of his life. From youth, he studied circus performance in Italy, and the United States where his mother works as a costume supervisor for Cirque de Soleil. “Traveling with the circus is never boring,” he says.

It has been forty-four years since the Togni family last appeared in Ghana. Times have changed, and the entertainment market is unforgiving. In the interval several major circuses closed their tents permanently. However, the Togni’s continue to electrify their audience. At times the journey takes them into exotic, conflicted, and dangerous territory. In 2009, the circus was nearly stolen in Iran when an opportunist sponsor used the Twitter Revolution as an excuse to keep their tent and everything in it. They were forced to escape on a late night cargo ship organized by Uncle Livio and spent the next year entertaining a mysterious Oil Sheik in Qatar.

The Togni family owns a three uniquely arranged circuses. “When we come to places like this (Ghana) we bring the small circus. This is most peoples first time, so they are still amazed by the traditional acts.” The family business is headquartered in Lombardy, Italy. Their home-base is a large compound house on a ranch where family, friends, performers, giraffes, elephants and tigers are a welcome and common. But many of these performers haven’t seen home in years. Constant travel can weigh heavily on group dynamics and mileage with animals, artists and loads of burdensome equipment can revert to utter chaos.

Patriarch and animal trainer Davio, has a substantial scar on his abdomen. When asked how he got it he is quick to redirect the discussion. His son Daniel is more willing to tell the story. “He didn’t get it from the tigers,” he says with a laugh. The wound was left by one of two Brazilian brothers, once a part of the Togni’s circus. “It was the moto-boys. They were with the circus a while but they were drunkards,” says Daniel. “One night, they got drunk and one punched up his girlfriend’s face (a fellow performer- name withheld),” says Daniel, shifting to a serious tone. “My Father was teaching him a lesson when the other brother stabbed him.” He says, thrusting his right arm in front of him. “They took off and left my father with the knife still in him.”

Davio bled profusely but retained consciousness and enough strength to secure medical attention. The brothers fled to the nearest Brazilian embassy, leaving their bikes and other articles behind. The incident left the Togni family’s leader in hospital, a female artist unable to perform and no-one able to execute the final act. Rather than shut the tent, the crew rallied together. The Wonderboys, a pair of juggling, tight rope walkers from Colombia decided to give the Globe of Death a shot. By the time Davio was released the pair had mastered the act and perform it nightly ever since. “This is the way in the circus,” says Daniel.

Now, Yecid has performed with the Togni family’s circus for more than two years and his clowning has brought smiles to international faces of all ages. He sleeps backstage in a shipping crate cluttered with over-sized wardrobe changes, prop jokes and other more banal necessities of life. He has five children of his own, all in Venezuela, some in the circus and others who are not. “It is their decision, I would never force them into this life. But they know it is the only life for me.”

The Togni’s “Il Florigielo” Circus Ghana tour has been extended. The big top will continue to host shows six nights a week in Accra’s Children’s Park opposite National Theatre until May 20th.

The children of Zion Bata

A young member of the Zion Bata church lies on the floor covering her ears. Photo by Desiree Buitenbos

The children of Kachitsa Village, a small village of 1,000 in the northern outskirts of Lilongwe, Malawi, are adamant about their religious beliefs. Mention God and their shy, soft-spoken demeanor converts to self-assurance and poise.

These children are members of a church called Zion Bata which preaches that prayer is the only effective method for healing the sick.

“Since I was born I have never had any drugs,” says 10-year-old Rezina Emphraim “It would therefore be wrong if I had any vaccination because we made a promise to God that we will never take medicine.”

All members of the Zion Bata church, including 600 children, are forbidden access to modern medical care. Those who do seek treatment for sickness are heavily judged and ultimately kicked out of the  community.

For the children of Kachitsa, their parents’ decision to join Zion Bata has influenced every aspect of their lives.

“When a child is born, we give him blessed water first before he takes anything of this world,” says Mrs. Chigona, the community midwife who would only give her last name “He is blessed first and then he can be breastfed.”

Some members of Zion Bata have never spoken to the media before, largely because their beliefs are highly controversial in Malawi.

In 2011, when the Malawian government made the measles vaccination mandatory, health officials visited the village and found not a child in sight. It was later discovered that they ran away to a nearby mountain to avoid any wrongdoing.

“If I took drugs, it would be a sin against God,” says 13-year-old Enelesi Haswel, “It is not right that I should receive any medicine.”

To an outsider, it seems like the strong commitment to the church is governed by a fear of relinquishment. But the leader of church, Inspector Jamieson Ofesi, says that members have free choice to take medicine.

“If a person has little faith, he can use drugs. We do not prevent them from taking drugs. But if they do [take drugs] we excommunicate them because we know that they do not have faith.”

According the World Health Organization, 110 out of every 1,000 children born in Malawi will die before the age of five.  And for every eight that die, one will be the result of a preventable disease such as malaria, diarrhea, pneumonia, or measles. Which prompts the question: Can the children of Katchitsa risk never seeing a doctor?

The physical appearance of the kids in this village is a testimony to the effects of prohibited healthcare.

The majority of them have scars, wounds or ring worms, and sitting in on the Sunday service is like sitting in a hospital waiting room. Young infants have worrying chesty coughs comparable to adults with bronchitis.

Malawian authorities have done little for the children of Zion Bata because the grey area between freedom of religion and the rights of the child is not yet defined.

Malawi practices religious tolerance, but children’s rights are a fairly recent phenomenon. The country only passed its first comprehensive act on child protection in 2010. Known as the Child Care, Protection and Justice Act, Article 80 states that “no person shall subject a child to a social or customary practice that is harmful to the health and general development of the child”.  Those found in breach of the article will land 10 years in prison.

Nonetheless, no arrests under this act have been made at Zion Bata.

Grace Malera is the executive secretary of the Malawian Human Rights Commission, and she admits to facing difficulties in taking a proactive stance toward investigating whether the children are severely suffering due to their parents’ personal choices.

“A matter like this one needs further and comprehensive research because that kind of research will enable to us to generate evidence which could then in turn inform relevant policy and program interventions.” Says Malera

For child’s rights activists like George Kayange, who is the founder of the Child Rights Information and Documentation Centre, the central focus is the government’s role as a duty-bearer who has ratified the UN convention of the rights of the child.

“Government must take action in terms of ensuring that the best interests of the child – as enshrined in the convention – are being guaranteed,” Kayange says.

“It’s unfortunate that in many developing countries people use religion and culture as an excuse for violating other people’s rights, including children.”

With files from Teresa Ndanga

Radio waves inspire change in Malawi

Violet Banda presenting a Radio Timveni program. Photo courtesy of Timveni

Violet Banda is not your average 21-year-old.

A poised, confident and outspoken child rights activist, Banda personifies the power of radio in Malawi.

Born to a family of five children, Banda is the only female and the only child to have contracted HIV from her mother who succumbed to AIDS when Banda was just three years old.

“When I found out I was positive, I was in primary school,” says Banda, “Whenever I would tell people about my status it happened that I lost all my friends. Some didn’t want to be near me or touch me. They just ran away. “

HIV/AIDs is the leading cause of death in Malawi, and Banda says the stigma she faced growing up is a common reality for the half a million AIDS orphans in the country.

For Banda personally, the discrimination affected her ability to perform at school, as well as her relationship with her family.

“It felt like they should do their own thing, and I should find other friends in the world”

But all of this changed when Banda turned 15, and was invited to speak publicly about her experiences on a children’s radio show run by a local NGO called Timveni.

Phillip Kamwendo is the programs manager at Timveni, a media project which focuses on children’s rights and creates space for children to anonymously tell stories about the issues that affect them. He recalls the first time Banda came on air.

“Her grandmother could not accept that she was HIV-positive until she came on our radio program,” Kamwendo says, “She told her story and how she feels, and her grandmother was listening. Afterwards, she changed her mindset towards her granddaughter.”

That wasn’t the only difference in Banda’s life.

Following her radio debut, she became a youth reporter for the project, where she’s enjoyed success in highlighting violence and abuse against children. Many of her stories grapple with issues like rape, child labour and forced marriages – and her work has often had a positive and immediate impact on local government policy.

“I once interviewed this girl who was raped by her teacher and had dropped out of school,” Banda says. When we brought her on the radio, the ministry of education took action. They fired the teacher and the girl returned to her studies.”

Banda along with her many Timveni colleagues are from humble beginnings. In Malawi, 80 per cent of the population lives in rural settings where electricity, clean water, and money are scarce. One form of entertainment for the rural masses is the radio, particularly so-called “listening clubs” where community members huddle around a battery-powered radio to hear a show of interest.

According to a national survey, 96 per cent of the population uses radio as their primary source of information. With such a large audience, it’s no surprise that organizations across the country are investing in listening clubs because of their influence in even the most marginalized communities.

Similar to Timveni, Story Workshop is a non-profit organization which produces dramatic portrayals of real-life human rights scenarios on-air. They sponsor 60 listening clubs and use the feedback they receive to inspire new content and measure their impact.

In addition, the Malawi Broadcasting Corporation (MBC) recently donated radios to 30 clubs across the country, while smaller NGO’s like Child Rights Information and Documentation Centre (CRIDOC) are hoping to do the same, provided they can get the funds.

For Banda, radio not only improved the quality of her life, but it also opened the doors to experiences she never thought possible. As a child rights activist she has travelled the world, and just last year, she gave a speech at the Oslo Freedom Forum in Norway. She maintains that the mass medium is the cheapest, most effective tool for change.

“It is the only key to awareness in Malawi” she says.

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Down the road to BASCO

Vida sits in a scratched wooden chair beneath the only coconut tree in a clearing. She has a series of line scars next to her eyes and mouth, three sets of four, twelve marks in all. “I got them from my mother,” she says. “When I was a baby I was sick she gave me them to keep me healthy.”

The fifteen year-old is outgoing, pretty and popular amongst her classmates at the Baptist School Complex and Orphanage (BASCO). “I was only a small girl when I came here. I don’t remember who brought me,” she says. But her eyes convey a knowing sadness as she speaks of the past. She made the trip here a decade ago, up a rugged and isolated path cut through dense jungle brush. Many children have walked the same path since.

Pastor Victor is BASCO’s director. He is tall, dressed all in white with gold trim and refers to the students as his children. He says he remembers Vida’s first day, “we didn’t even have buildings yet. Taught the classes standing under the shade of cocoa trees.” He says Vida had to overcome several challenges. “When she got here she would never talk. For two years she would never say anything. Just a sobbing little girl. She would eat sometimes but she didn’t trust anyone yet. It was so serious you could see she had been traumatized,” says the pastor.

“I wasn’t scared just sad sometimes when I would think of my mother,” says Vida. She shrinks in her chair, stares at the ground and drags lines in the sand with her feet. It is clear she is uncomfortable with the topic.

“Her father died in an accident and her mother was murdered in front of her not long after. Her family thought she was a bad omen. Strange where people find Satan,” says Pastor Victor.

The sobbing little girl is now a young woman and well adjusted survivor. Her development is paralleled by the institution’s. She is one of many success stories in a facility that now feeds and houses eighty-six children and educates more than two- hundred. The schools budget is stretched thin but the staff has developed ingenious methods of assuring students are well taken care of. The compound has evolved to include classrooms,dormitories, washroom facilities, a kitchen, health centre, computer lab and their most recent project, a snail and pig farm.
“The farm will help make us sustainable and self-sufficient,” says Pastor Victor, while examining the wooden boxes filled with snails. “We want to use the money to help our older children continue their education,” says Victor. “We plan on offering vocational training here soon, but these kids have the potential to be anything they want. All they need is funding.” Currently, BASCO is dependent on the donations of benevolent individuals and agencies. The school teaches students between the ages of four and fifteen. Vida is studying for the last round of the final exams the school has capacity for. She wants to be a medical doctor and dreams of a future unimaginable when she took her first steps under the shade of BASCO’s cocoa trees.

Opportunity in Organics

Ghana’s investment in organic farming could transform the country’s agriculture sector and improve the country’s economy dramatically.

It’s a common scene among many small-scale farmers in Ghana: men and women working feverishly under the hot sun, mixing cow dung and chemical pesticides into barren soil, harvesting salvageable produce to sell and praying for incipient crops to grow. It’s not like these farmers aren’t trying. It’s not like they don’t know what they’re doing. It’s a twofold problem. They are working in a relentless climate defined by very high temperatures, inconsistent rainfall, and soils prone to erosion and degradation. Additionally, the agro-education they have inherited is unsustainable – a blend of traditional practices such as bush-burning and modern habits of using pesticides and herbicides are harmful to the environment and not ideal for food production.

[pullquote]Organics are more resilient and have a longer shelf life than chemically-grown food. Since many farmers have a limited knowledge of post-harvest care they lose between 20 and 50 per cent of their yields. Organic plants are nourished naturally, and therefore more robust than conventionally-grown plants.[/pullquote]

Agriculture dominates Ghana’s economy, contributing to 40 per cent of the country’s gross domestic product. But the sector is plagued by erratic weather patterns, low crop yield, low soil fertility, unsustainable agricultural practices, poor quality produce and limited access to market.
Ghana’s agriculture sector is in need of an overhaul. An investment in organic farming could revamp the sector by introducing superior produce that is more resilient, encourages the sustainable use of land, is more nutritious and has a higher market value. Organic agriculture could provide Ghana’s economy with a much-needed boost.
One small organic project farm in Agona Town, west of Cape Coast, could be that boost. The farm, called the Abusua Sustainable Organic Farm (ASOF) project is attempting to tap into the organic industry and convince the country of the benefits in organic farming. Organic farming in Ghana is largely unexplored. Currently, very few people in Ghana are making money from organic farming although organic food and beverages generate almost $51 billion in global sales.

part of the ASOF project’s farmland- cassava is already growing.

Arriving at the Abusua Foundation’s 15-acre plot of farmland I understood why our guide, executive director and founder Simon Tsike-Sossah, chose to wear long pants and sneakers that day. We stepped into a mass of wild, overgrown plants and pushed our way past prickly bushes, tangled vines and aggressive, biting ants. We were enclosed in a fortress of foliage- large glossy leaves, tiny yellow flowers, rich red soil and multiple shades of green. This is this site for ASOF. Here Tsike-Sossah hopes to establish an organic youth-run farm where sustainable farming methods become a profitable business. The founder furthered his childhood knowledge of organic farming techniques with a formal education at the University of Cape Coast. “We want to show you that you can do farming in a better way,” he says.
Organics are more resilient and have a longer shelf life than chemically-grown food. Since many farmers have a limited knowledge of post-harvest care they lose between 20 and 50 per cent of their yields. But, organic plants are nourished naturally and are, therefore more robust than conventionally-grown plants. Organically grown food is also less susceptible to rapid mould, rotting, diseases and pests.
Ghana is typically a hot and dry country. Dry, dusty winds blow through the country and, especially in the north, recurrent drought severely affects agricultural activities. Organically grown plants are more drought tolerant – a benefit as 69 per cent of the country’s land surface is prone to severe erosion. Because chemical fertilizer is soluble, plants are forced to absorb it every time they are exposed to water. When water supplies are limited, chemically fed plants are unable to absorb enough water to reach toxic concentrations and stop growing – a major issue in a country with less than one per cent of its arable land irrigated.

[pullquote]“You are not taught that you can actually make do by not applying pesticides. It’s a feeling of the very old-age practice that what the white man does should be right,” says Tsike-Sossah. “To tell them the opposite, they think it’s not possible.”[/pullquote]

It’s also cheaper – important in a country where 45 per cent of people live in poverty (less than $1 CND per day) and the majority of the country’s farmers are small scale “peasant” farmers, unable to afford expensive pesticides.
Ghana’s produce is not largely sought after on the international market as many farmers’ goods do not meet necessary quality standards in terms of weight, grade and sanitary requirements. But western consumers recognize the greater value of organic produce and are willing to pay high prices for it. In 2009, organics generated $25 billion in North American sales alone.
“If you get your organics certification, it’s a whole goldmine out there,” says Tsike- Sossah, referring to the European and West African market.
The Abusua team plans to get surrounding community members involved and benefitting from the ASOF project. It plans on building a surrounding network of farms, helping other farmers improve their agricultural approaches and techniques. Annie Leff, an Abusua Programs Manager, spent several months researching and speaking with the community famers and found an interest in organics. “Everyone has at least heard of organic farming and knows it is good for the body,” says Leff.
Currently, maize, cassava, yam and rice are the most commonly-produced crops in Ghana. They’re high yielding and relatively easy to grow, but they’re not very nutritious, a problem in a country where 8 per cent of the country’s total population is undernourished.

Simon Tsike-Sossah, founder of the Abusua Foundation, smiling as he looks down at the future location for the ASOF farm

“People eat too many carbohydrates,” says Charles Adams, the Regional Minister of Agriculture in the Upper West Region. “We need to integrate more nutritious crops into the agriculture sector, especially vegetables.” Organically-grown food is higher in mineral content than non-organics. It’s also free of contamination to health-harming fungicides, pesticides and herbicides. Healthy plants, mean healthy people.
The Government of Ghana made the environment’s health an agriculture sector priority. However, Ghana’s environmental management rules and regulations are weak. Traditional practices such as using chemical pesticides, bush burning, the process of setting bush and forest ablaze to clear land quickly, and monocropping, growing the same crop year after year on the same land without rotating crops to replenish the soil with essential nutrients, trashes the land causing soil to dry and erode . Leff says this is due to a simple lack of understanding. “People are only thinking of agriculture in the very short term. By slashing and burning and using chemical pesticides they see fast, short-term results.”
Organic farming isn’t catching on because for years farmers have been taught that pesticides are a must for good harvests. “You are not taught that you can actually make do by not applying pesticides. It’s a feeling of the very old-age practice that what the white man does should be right,” says Tsike-Sossah. “To tell them the opposite, they think it’s not possible.” Farmers using organic techniques produce food at a slower rate and in smaller amounts, but end up with superior, healthier and more valuable products.
The Abusua team hopes to have their entire 15-acres cleared in the next two or three years, so they can start growing peppers, tomatoes, cabbages and carrots. But with no government support or funding, they’re relying on the help of community members and volunteers doing all their work by hand. “One of the things we are doing is not only telling people you can do farming in a sustainable way, but showing that you can also make very good money out of it,” says Tsike-Sossah. “You can still wear a suit and do farming if you want to.”
Tsike-Sossah and his team are focused on practicing what they preach. They have started a one-acre experimental garden where a few dedicated people including Stephen, an ASOF farm hand and its first official employee, spend their days tilling the land and planting seeds into well-designed furrows equipped with irrigation trenches. They even dug a 10-foot well that struck water after only four days. However, the Abusua team is strapped for resources. They still need a pumping machine, sprinklers and farming tools. They would also like to dig another well to really get the project off the ground. They believe in the project and the numerous ways organic farming could improve Ghana’s agricultural woes – so they continue dedicating their days to the cause. “As long as we are on the ground cropping with the organic technologies we are espousing, then I’m sure we will be able to influence many people,” says Tsike-Sossah.

Challenging Corruption in Ghana

As Ghana undergoes the public consultation phase of its constitutional review process, citizens are forced to question their democratic values and whether or not their political institutions are protecting these ideals. Considered to be central to good governance and effective society is an absence of corruption, but governmental institutions existing to deal with cases of corruption are raising questions about whose vision of justice is actually being served under the existing system.

The Serious Fraud Office, Ghana’s foremost governmental anti-corruption institution, was created in 1993 under the Ministry of Justice and the Attorney General to investigate economic crimes against the state. However, a strangling hold on its powers by the Attorney General’s Office impedes its effectiveness. “The institutions that fight corruption are so attached to the executive. They are simply not working,” said Professor Amakye Boateng, a political science lecturer at the Kwame Nkruma University of Science and Technology (KNUST). “The interesting thing with our democracy is that when you have Party A in government, the cases that get prosecuted involve parties of the opposition. So when you have another party coming into office, then you get the cases of their opponents getting prosecuted. So, they will tell you when they get in power that there is no problem,” he explained. Boateng credits this issue to the fact that the Attorney General, who holds the ultimate decision whether to persecute a fraud case or not, is appointed by the president, and therefore likely to favour cases of the party in government.

There is concern about the disproportionate number of corruption cases prosecuted from within the parliamentary opposition. While the Attorney General regularly prosecutes crimes from within the opposition parties, many worry that issues of corruption persist untried within the Government. The appointment of high government officials such as the Attorney General is always a contentious issue in Ghana as it fits into the current debate about how much power should be vested in the presidency and places unnecessary pressure on public officials to abide by the wishes of the ruling party out of the fear of losing one’s post.

Ghana’s official government website even speaks highly of the fact that recent cases against the state brought to the SFO have all been ruled in favour of the government. In a section listing the accomplishments of the SFO, it reads, “The Ministry has dealt with a lot of constitutional codes, prominent among them are the Attorney General verses the NDC on three different occasions which all was ruled in favour of the government, as well as the Attorney General verses Tsatsu Tsikata on the constitutionality of the Fast Track court”.

A possible solution for the lop-sided tendencies of the SFO is to give it the power to prosecute crimes independently from the Attorney General. Even if the SFO is granted a prosecution body however, there remains the fact that the SFO only deals with serious economic crimes. Any instances involving fraud that are outside of its financial purview are ignored by the government’s anti-corruption body.

The SFO, by design, investigates and tries only the crimes of corruption that result in a significant, economic loss to the state. Members of civil society, however, have embraced the fact that corruption can be found in virtually every sphere of life, in one’s day to day interactions with businesses or public institutions, and is not limited to crimes of a strictly economic nature. Ghana’s legal definition of corruption includes only bribery according to Florence Dennis, the General Secretary of Ghana’s Anti-Corruption Coalition. The Coalition, along with Ghana’s Integrity Initiative, a national chapter of Transparency International, are just two groups championing the fight against corruption in civil society. They prefer to use the definition prescribed by the World Bank which includes fraud, extortion and money laundering. Mrs. Dennis commented on Ghana’s idea of corruption, “We are growing. We realize that corruption is more broad [sic.] than it is. It’s like an octopus with so many [legs] and attached to so many things, so we need to broaden our definition of corruption.”

Another option would be to pass the general anti-corruption mandate to a different institutional body. The Ghana Integrity Initiative has been calling for the creation of an autonomous body through which to prosecute crimes of corruption. This does not solve the inadequacies of the SFO, and its own prosecution board would still need to be considered, but it provides an outlet for Ghanaians to have their claims heard, investigated and tried without direct influence by an appointed official.

The main objective of these proposed reforms is to have a body that can investigate and try corruption crimes independently from government influence. Therefore, GACC is advocating for a separation of the Attorney General and the judiciary. “The main issue is to separate the main prosecution body from the Minister of Justice so that we have an Attorney General who does not run like a political appointee. He runs as a professional appointed in his own capacity and he does his work professionally,” said Dennis.

[pullquote]“We really have to link corruption, fighting corruption, to human rights and then to poverty reduction for people to see the effect”[/pullquote]
In a public survey by the Centre for Democratic Development (CDD) to gauge public opinion on suggested constitutional reforms on various topics including justice institutions, significant majorities supported granting the Committee for Human Rights and Administrative Justice (CHIRAG) the ability to investigate cases by its own initiative instead of requiring an official complaint. A group of ‘household’ and ‘elite’ respondents were polled respectively in 22 regions with 77% of household respondents and 79% of elite respondents supporting this amendment. Currently, CHIRAG only has the power to investigate cases that have been brought before it, as well as being bound in the same way as the SFO by the Attorney General who “may” choose to prosecute a case or not after the investigation has been completed. Although the idea has been considered by the Constitutional Review Committee, the suggestion of giving CHIRAG its own prosecution powers was supported by 63% of household respondents and only 46% of elite respondents.

In the same study, 74% of household respondents reported that approval by a two-thirds majority in Parliament as opposed to only presidential prerogative should be required to appoint an Attorney General who is currently the head of all governmental justice bodies.

Though civil society is attempting to fill the gaps in Ghana’s anti-corruption institutional infrastructure, it is certainly not without challenges. The lack of a Freedom to Information Act makes it difficult to access statistics and figures relating to corruption issues. Florence Dennis described the frustrations that GACC is facing in trying to monitor and review the general anti-corruption process in Ghana, “That is a flagship work of the GACC, but it has been quite challenging because getting statuses on anti-corruption is not as transparent in our system as it is in other places. We’ve never had the actual figures, so we always talk in a vacuum.”

Monitoring all of Ghana’s anti-corruption laws and institutions is no small task. Ghana’s various pieces of legislation dealing with corruption issues include the Procurement Law, the Asset Declaration Law, and the Whistleblower’s Act and upward of 15 other institutions. Making significant in-roads is the Whistleblower Act, enacted in 2003. It places everyday Ghanaians into the role of social watchdog to guard against corruption, not only in Ghana’s legal sense of the word, but also the broad definition of ‘corruption’ that includes seemingly minor examples of fraud, perhaps in the school of one’s child, or in the daily workings of a hospital. The UN refers to these instances as ‘quiet corruption’. Though only a few dollars may be bribed, extorted or reallocated at a time, the aggregate effect can be a large loss to the community’s financial resources.

The Act encourages society members to report suspected corruption by providing them with the benefits of formal institutions through which to blow the whistle and police protection if needed. GACC has been holding workshops to train civil society on recognizing potential corruption cases as well as the process of whistleblowing as defined by the Act. Funding for their work with the Whistleblower’s Act comes primarily from a pool fund, called the Ghana Research and Advocacy Program, of which the Canadian International Development Agency is a major funding partner.

As civil society organizations continue working to strengthen Ghana’s various anti-corruption institutions, they are reaching out to the general public to impart that corruption is not only limited to financial matters in the upper echelons of society, but rather, that the effects touch everyone. “When you involve yourself in corruption, it deprives you of certain benefits that make you poorer. That’s when people will relate to it, but if you talk about corruption, and only in isolation, without relating it to poverty, without relating it to a development agenda, people will not see the effect,” said Mrs. Dennis of the need to connect corruption to larger development issues. “We really have to link corruption, fighting corruption, to human rights and then to poverty reduction for people to see the effect,” she said.