About 15 miles from Ghana’s second-largest city of Kumasi, where the pavement turns to hard-packed dirt and the African rainforest grows up thick and tangled, a story of transformation is unfolding. In Barekuma, generations of villagers have carved out a meager existence by farming the equatorial soil. They’ve lived on dirt floors and without electricity and toilets. Access to health care and education has been limited, and the water the community has always relied on for everything from laundry to cooking and bathing has been so contaminated that most of Barekuma’s 2,500 villagers became chronically ill.
Over the last eight years, though, a partnership with the University of Utah’s Global Health Initiative has led Barekuma to remake itself by engaging educators, medical practitioners, university students, and the community in a cross-disciplinary approach to problem solving that helps residents increase their own capacity to improve their lives and create sustainable change. Villagers now have—and use—clean water sources and restrooms. The incidence of disease has been reduced, and greater economic stability is being fostered.
Paired with education-centered programs for medical students and other health-care providers at the Komfo Anokye Teaching Hospital in Kumasi, the efforts in Ghana are a cornerstone example of how the U’s Global Health Initiative is charting new pathways for addressing the challenges of health, education, and economic development, not just in West Africa but in other developing nations and here at home. The initiative is now working in 20 Ghanaian villages and changing the lives of more than 30,000 people. Recently created programs in India, China, and Peru are in their infancy, but already have enhanced opportunities for learning for more than 100 students and faculty members.
Some may wonder why the University of Utah should focus resources and talent on solving problems in places half a world away, when there are community health challenges here in the United States. But in a shrinking world, where global travel is common and refugee programs relocate tens of thousands of people from the developing world, medical providers in Utah need the skills to recognize and treat a wider variety of diseases, say the U Global Health Initiative’s co-directors, Dr. Stephen C. Alder and Dr. DeVon C. Hale. Alder is chief of the U Medical School’s Division of Public Health, and Hale is a U professor of internal medicine and pathology, whose specialty is exotic diseases and travel medicine. They note that many ailments in the developing world can be prevented and treated, so enhancing health education both in medical schools and communities abroad can markedly improve many people’s quality of life.
“The reason we’re in Ghana or China or Peru or India is that we can learn so much in being a part of that community,” Alder says. Hale agrees and says, “I think it’s important that we sitting here in Salt Lake City, Utah, realize that we’re part of the world.”
The U Global Health Initiative’s approach differs from other international programs, Alder says. “We’ve come in, and we’ve looked at the comprehensive health system,” he says. “The community is our patient. And we think that for a healthy community, you certainly need great clinical care and great care delivery systems, but you also need clean water. You need sanitation systems. You need immunization. You need good, clean food; people that are educated; economic viability; and you need good government.”
University of Utah professor Stephen C. Alder, right, shakes hands with Nana Joseph Tabiri, the Ashante Tribe’s chief of Barekuma, joined by Ghanaian pediatrician Daniel Ansong, left. (Photo courtesy Stephen C. Alder)
Started by Hale in 1998 and spurred by medical students’ desire to help in the world’s developing countries, the largely volunteer program is something of a happy accident that has grown in unexpected ways. What Hale first envisioned was nothing more than an exchange program that would send medical students and residents abroad for clinical care experience in the developing world. His own interest in exotic, infectious diseases was fueled by a travel study he conducted of health risks and medical resources in 25 countries where missionaries for The Church of Jesus Christ of Latter-day Saints were at work.
With Hale’s help, many U medical students went abroad, and most returned with wide smiles and tales of invaluable learning. Others had spent frustrating weeks in locales severely strapped for resources or were used as the vacation relief for overworked local staff. In Swaziland, for example, a female resident arrived to find herself left alone to care for a ward of 40 patients suffering from HIV. “That isn’t a position we want our students in,” Hale says.
Hoping to do better, in 2001, the U Medical School partnered with Indiana University, which had a well-established exchange in place at a Kenyan hospital. The plan was to study Indiana’s program before deciding whether Utah should attempt one of its own, Hale says. But a persistent group of students kept up the pressure for a program through the U, and that same year, the University launched its own fledging program at the Komfo Anokye hospital in Ghana. Ten students and Hale made the first trip, spending a month working on immunization efforts and breast-feeding education, as well as weighing babies and treating dehydration in children.
From the start, the U wanted to build a collaborative, long-term relationship to enhance medical education and training rather than provide one-time donations of money or medical supplies. Hale ended that first visit with a promise to doctors and administrators at the Komfo Anokye hospital that he would return the next year with a new crop of students. “They were suspicious of us,” Hale says of his Ghanaian counterparts. “By the third year, I think they realized maybe we were serious and would keep coming back.”
It was a critical turning point. In 2004, Hale recruited Alder to join the program. Alder had been seeking a way to add an international component to public health education at the U, and he helped the Komfo Anokye hospital develop community-health-oriented outreach and programming. The two Utah doctors were then invited by Ghanaian physician Daniel Ansong to Barekuma. Ansong and two other doctors had adopted the village as their own and were working to try to improve the community’s health conditions. “We went in pretty naively, and our partners went in pretty naively, but we very quickly realized that there were some incredible opportunities for us to make a big difference,” says Alder.
U medical professor DeVon C. Hale, center, listens to residents in Barekuma, Ghana. He says listening has been key to the Global Health Initiative’s success. (Photo courtesy U Global Health Initiative)
In Barekuma—and shortly thereafter in the smaller villages of Kumi and Anikroma—Alder and Hale met with the village chief and other leaders, trusting their assessments of those projects and problems that most needed University help. “Our philosophy has been that we don’t go take charge of a system or a program, but we go as support, as partner,” Alder says. “There are times when we can be a mentor or a technical adviser, but we also go there to learn.”
A prime example of how that process has worked is a Global Health Initiative research project mapping the prevalence of a parasitic flatworm disease known as schistosomiasis. The chronic disease, which is transmitted through human urine and contracted through exposure to contaminated water, was a known health problem that the community wanted to address. The U doctors got community participation in their research project by starting at the top. “We had everybody pee in a cup. The chief started it out to demonstrate that this was a good thing to do,” Alder says. “We did it appropriate to Ghanaian culture, and we got great participation.”
Testing found 41 percent of villagers suffered from the disease. The U team compiled the results into a report and suggested mechanisms for changing local practices and reducing disease. The findings were presented at a community meeting. “There were just these fantastic debates about what this all means, and we never got to the solutions because the community did it before we could. They fixed it,” Alder says of their resolve to find ways to avoid using or getting in the contaminated water.
Other projects have included a health census of villagers and Global Positioning System mapping to better track the spread of disease, early identification and treatment of malaria, efforts to stem the transmission of rotavirus, continued schistosomiasis studies, and the development of sanitation and water treatment systems. A community-based medical clinic that will provide primary medical care and prevention programs for 5,000 residents in five villages also has been completed and is set to open this year. The U doctors this year also launched the Healthy Families Initiative, a program based on the Ghanaian government’s plan for health care that places community health nurses in local clinics.
Working in concert with the Ghanaian government, the U Global Health Initiative helped secure funding and building materials for two schools in the village of Anikroma, with labor supplied by local villagers. In Barekuma, U teams have helped build a community bathroom facility near a school and install a sewer system, so villagers no longer have to use an open pit covered with boards for a toilet. And U students helped write a grant that secured loan funding so villagers could transform a five-acre plot of unused land into an orange grove. Proceeds from the sales of the fruit and its juice will provide an ongoing revenue stream to increase the village’s economic viability and help break the cycle of poverty.
Even more exciting for Hale is what’s happening back in the Kumasi hospital where the U program has its roots. Each year, more students and faculty from both countries have become involved, expanding opportunities for research and learning. The annual summer medical exchange that brings Hale and U students to Africa now also allows for Ghanaian students and faculty to come and study at the University of Utah. About 40 U faculty members are involved and have developed new residency, teaching, and training programs for budding doctors, nurses, dentists, laboratory technicians, and community health workers, as well as physicians’ assistants, who play a critical role in health-care delivery across Ghana and are often the first, or only point of contact a rural village may have with medical care.
The difference the U program has been making is dramatic. An ophthalmology program has expanded access to cataract surgery for patients of all ages, and the Global Health Initiative has helped build an eye surgery center in Kumasi that is nearing completion. Infant mortality is decreasing through the efforts of a neonatal resuscitation course, as well as a new method for treating severe dehydration in babies. A growing dental program for Ghanaian students will graduate its first class this September, improving access to dentistry in a place where the dentist to patient ratio is one per 80,000 people.
A Ghanaian medical worker takes a blood sample. (Photo courtesy U Global Health Initiative)
The University’s success in Ghana has drawn plenty of attention to the community, and requests have come in recent years to expand the Global Health Initiative. Programs and medical exchanges are now in place or in development in China, India, and Peru, opening new opportunities for U students and faculty and those in host countries, Hale says.
Hale and Alder now have a very specific dream: a Global Health Institute at the U that would support both the work already under way and serve as a launching pad for new endeavors. The institute would help them foster new collaboration with universities worldwide and sponsor conferences and research. Hale says a formal institute would also lend the kind of credibility needed to win grants to support the work.
To date, participants in the Global Health Initiative have self-funded most of their work and travel. The U’s medical school provided Hale with a small budget of $60,000 for the first time this year. A fully funded institute would create the needed stability to hone the focus on programming, rather than finding the money to fund the work, Alder says.
For students, working in Africa is as much a lesson in trans forming their own perspectives as it is in medicine, public health, or any other discipline, says Chris Brown, the current chief resident at University Hospital. Brown has traveled to both Kenya, where the University remains involved with the Indiana program, and Ghana. “Their resources are much more limited, so simple lab tests and things that we order here without even thinking about it are very costly, or sometimes you can’t get them,” he says.
He believes he has become a better doctor because of the time he has spent in Africa. He has encountered diseases, sometimes at very advanced stages, that he might never have seen at home. He thinks more about the implications of expensive diagnostic tests and tries to rely more heavily on doing what he says his Ghanaian counterparts do so well: listening closely to patients and conducting more thorough health histories to map a path to diagnosis. He also has a deeper commitment to a medical career entwined with public health work.
University of Utah ophthalmologist Alan Crandall, right, performs eye surgery on a child in Ghana, with Ghanaian ophthalmologist Peter Osei-Bonsu, left, and U nurse Brittnee Zacherson. (Photo courtesy U Global Health Initiative)
Stephen Oluaku Manortey, a Ghanaian who is now studying in Utah in the U’s doctoral program in public health, says conducting community-based participatory research with the Global Health Initiative has allowed him to develop a deeper understanding of the health challenges his country faces. “It has helped me learn more about my own backyard,” says Manortey, who plans to work in Ghana after finishing his degree.
The Global Health Initiative has developed health centers there that bring primary health services to rural communities and has created a database of demographic and health data that aid disease surveillance work. Efforts like those are changing Ghana’s health systems, all without creating a dependence on foreign partners, he says. “This has helped my people to see themselves as stakeholders and owners of the projects much more than the foreign counterparts who have come to work with them,” Manortey says. “I think the GHI is having an impact in Ghana and is there to help make Ghana and the world a better place.”
— Jennifer Dobner is a former longtime Associated Press reporter and editor who now is a freelance writer based in Salt Lake City.
If you would like to participate in a service trip or visit any of the Global Health Initiative sites, or make a donation, contact Taylor Scalley at (801) 585-6874 or taylor.scalley@hsc.utah.edu.
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