The rainy season brings public toilets

Crouched on the bed, back against the frame, my head tentatively shifted forward - a squiggle line of ants crawls on the creamsicle - colored walls behind me and after five weeks of sleeping in Martha’s house I’ve come to learn these ant farm paths.  In the living room I hear the TV, news channel.  The last case of Guinea worm has finally been eradicated in the North of Ghana, a great success.  I have lived and breathed Ghana for the past 35 days and learned just what this country can do, for its people and for me.

The past two years I have come to Ghana in March on a medical service trip.  Students from the College of William and Mary come for just ten days to run temporary clinics in rural communities in the Volta Region.  As trip leader for the last trip, it finally seeped in how unsustainable our program was.  We hired Ghanaian doctors to prescribe the medicine we fundraised to buy and as a result, the community members were charged 3.50 GHC.  The medicine was free but the service was not.  After a month or so, the medicine we prescribed ran out and in order to refill, the patient had to go to their nearest health center.  In short, our service had an expiration date of…one month; not very sustainable at all. 

Grants were applied for, tickets bought, and HCDP contacted.  Richard Anku, director of HCDP and a self-made man was the key.  My fellow trip leader and I knew Richard from one of our previous trips.  We called him up and explained our goal – to spend five weeks in Ghana interviewing members of the communities we served back in March.  We wanted to collect basic demographic data on the people we served and ask them straight up, “Hey, what do you need for your community? What medical service do you want?”

Richard brought together a dream team: himself, Ralph, and Patience.  For the next four weeks my research partner, Mary Kate, and I interviewed over 600 folks at five different communities.  While we quickly brushed up on our Ewe, we thankfully had the dream team to trudge from house to house and translate every one of those interviews.

The communities were beautiful - tucked away along mountain ridges, clouds heavy with rain drifting past with the morning breeze.  Those interviews, all those people, you can’t learn Ghana any better way.  Farmer after farmer, seamstress, carver, fish trader, banku seller, assembly man, chief – learning how people spend their days, how many kids they have, what they do to prevent sickness, what they do when they themselves are sick, and of course, the big question, what I always waited on tenterhooks to hear: what does your community need? what do you want?  Some folks were shy; others excited to speak to the two yevus.  But every single soul invited us to their home, brought us chairs, and sat – waiting patiently for the first question.  We learned more than just need.  We learned life.

From the first community Akpafu to our very last Tafi-Abuife, we found the answer to our big question.  Ghana has national health insurance.  As a result, the wants and needs we predicted were completely different. In 2006, Ghana implemented the National Health Insurance Scheme (NHIS) and now people can pay about 13 GHC for a health insurance card which must be renewed yearly.  With this card a person can receive general first aid and basic health care at the low low price of…zero cedi.  No consulting fee, no service fee, and most of all no medicine fee.  So as of 2006, our temporary clinics that charged 3.50 GHC per patient were not that great of a deal.  We covered the few folks who didn’t have health insurance and cut out any transportation cost but in the end, we were pricey.  The real need: health centers, more medicine at the present clinics, roads repaired, school buildings furnished, water taps fixed, public toilets built, and so many other ideas became our answer to the big question. 

The last week, with an immense amount of input and help from Richard, we fleshed out a brand new program for the service trip.  We analyzed the data from our interviews and recognized what 15 college students can really handle – the outcome, building an eight-seater public toilet.  The decision of which community…data analysis, pro/con lists, hour upon hours of discussion, and ending with a secret ballot we finally chose the cool, cloud misted, end-of-the-line town of Fodome – Ahor. 

The goal is a public toilet but getting there, the actual creation of this ideal preventative medicine structure, is so much more important.  The community must be involved.  The community, all those farmers, seamstresses, banku sellers, and traders must feel like they own that building, it’s theirs, they made it, and hey, they’re gonna take care of it.  Sustainability is a long, strange, hard to wrap your brain around word but in terms of public toilets…sustainability means working together.

Richard Anku organized the design of the building, got a 3-D model made, hooked us up with contractors, hardware sellers, and the list goes on.  But best of all, Richard brought Mary Kate and I back to Fodome so we could meet with the chief, all the elders, and the assembly woman.  We sat outside on chairs, wooden benches, under the shade of a sturdy tin roof.  The rain cooled and refreshed us, while it filled our ears with its steady ring of tin.  Richard went over the details and the ultimate condition: we must work together.  Heads nodded all around and smiles spread from ear to ear.  The elder in charge of development, Godfried, told us about the masons and carpenters in town.  There were even artisans in Accra, native to Fodome, who planned to help.  Women agreed to help cook for the workers and the width size of the cement blocks was even discussed.