Remotely aware
- Community-based awareness project in rural Ghana

Agbe Komla Ernest used to work as a welder and be the family breadwinner. In the photo he

is hospitalised with infections in both legs, incapacitated for a good while into the future.

With an average of 1 medical doctor per 14,000 inhabitants in Ghana and 1 traditional doctor per 80 inhabitants, it is no wonder that many people turn to traditional healing like Mr. Ernest did when his legs felt numb. According to traditional beliefs, every illness has a reason and a cure, and the scientific description of diabetes as a chronic disease that cannot be cured – only managed and controlled - is difficult to fathom.

Volunteering to make a change in remote areas

In her work as a public nurse, Vivian Tettevi realised that people die of diabetes unaware and she wanted to change that. “I was already engaged in volunteer work at the Sabbath Christian Church of Ghana and it was an obvious platform for doing community based work because we had a good network in the region,” she says. She is project responsible for a project supported by the World Diabetes Foundation to reach remote areas and establish community-based diabetes centres throughout her native Volta Region. Her husband Maxwell Abu is Project Field Coordinator, and together they dedicate all their spare time volunteering on the project.

Since 2005, the project has covered 15 out of 19 districts and done awareness raising and screening activities in 450 communities. An estimated 15,000 people have been screened including some repeats when people have returned for check-ups. The awareness material they use consists of pictures showing people who smoke, drink alcohol, eat badly, urinate frequently or who lose weight without explanation. They talk about the pancreas that produces insulin vital for the body to use and store sugar and explain that sugar is not stored or used properly if insulin is lacking or not working effectively and this causes diabetes, putting their health at risk. In an average community, 40 people are screened and 5 will typically have high blood sugar. If they are at risk, they are offered transport to go to a public screening centre for regular check ups and drugs - the latter mostly in theory as drugs are scarcely available.

Volta Star 95.5 FM

“Radio is doing a great job in spreading awareness. TV is not affordable to all, but everyone

has a radio – even farmers. I know the impact the radio has on them. You see, the radio goes

everywhere – even to places where cars only find dead end roads. For me, the community

outreach project and the radio go hand in hand and support one another.” (Radio reporter, Edith Amenuvor).

In addition to the camps, the project also conducts awareness raising through the media, and the collaboration with the radio is particularly important. As a regional branch of the Ghana Broadcasting Company, the Ho-based Volta Star Radio is the only public radio station in the Volta Region and it covers every corner of the region. Edith Amenuvor is a presenter at the Volta Star and her announcements and programs comprise an important element in spreading awareness about diabetes. On the radio she makes announcements about free screening camps, and sometimes she attends a screening camp to later report about how many people turned up and how many were found to have diabetes.

She also broadcasts messages about diabetes, but she is always careful not to scare people or stigmatise those who have diabetes: “I focus on saying that they should take care of the food they eat and that they should go to hospital regularly for their check-ups. If they do so they will avoid complications. The way I go around more detailed messages about blood sugar, is by inviting a guest to the studio, who can talk like an expert,“ she says. 

At the forefront of public health care

Originally, the project set out to establish 20 diabetes awareness and screening centres outside the Ministry of Public Health structure at places where no health services were offered. However, the project was overtaken by the introduction of a National Health Insurance Scheme offering free health care and treatment for its members at public health clinics. The establishment of a public health alternative outmatched the basic centres under the project, and that is why only 10 centres are operational instead of the intended 20.

The public health system has attracted people with diabetes to have their screenings and check-ups done for free if paying the annual membership fee of USD 12. As a consequence, the need for attendance to the diabetes centres established under the project has lowered. “We see this as a positive development,” says Ms. Astrid Hasselbalch, Programme Coordinator at the World Diabetes Foundation. “We do not want to create parallel structures and we recognise the public health services offered by the Ministry of Public Health. Our funds supported basic awareness and screening centres when there were none, but the public clinics are of course preferable now that they exist.”

The Regional Hospital in Ho is the main hospital in the Volta Region, home to 1.9 million people. In addition, the region has two district hospitals in Jasikan and Adidome and primary care health centres at district level run under the Ministry of Public Health. The Ministry of Public Health estimates that there is one doctor per 28,000 inhabitants and one nurse per 1,300 inhabitants in the Volta Region.

Challenges ahead

In spite of a positive development and an approximate 60% adherence to the National Health Insurance Scheme, resources remain scarce and the challenges all-pervading. The diabetes clinic at the Municipal Hospital in Ho is the referral clinic for diabetes patients in the entire Volta Region. Dr. Daniel Agbley is the only diabetes doctor and together with two nurses and two assistants they run the diabetes clinic in Ho. The clinic is open Monday to Friday with 40-50 diabetes patients attending daily. An estimated 2,000 diabetes patients are registered at the clinic, but the number is uncertain because the otherwise detailed record system is not numbered.

While appreciating the outreach work done by community based organisations (CBOs) like the Sabbath Christian Church of Ghana, Dr. Agbley also sees room for improvement: “The CBOs work with us in the sense that they go to the remote areas that we are not able to go to. They do a tremendous effort in reaching deep into the communities,” he says. However, he himself would like to conduct home-visits and train people locally and make them understand why it is so important to come for check-ups. “Oftentimes when patients go home from the clinic, they do not see the urgency to return for their check-up visit and then they only come back when it is too late and they have developed a complication. There is a lot of work to do in terms of awareness raising,” he says.

Ms. Astrid Hasselbalch recently visited and monitored the project in the Volta region. In the light of Mr. Agbe Komla Ernest’s and many similar stories about diabetes patients who had first gone to a traditional doctor and finally come to the clinic when the diabetes effects had developed into complications, she recommends that the project emphasise on awareness activities and in particular include traditional doctors: “This is crucial because they are very powerful in the communities and they attend and treat many diabetes patients. If the traditional doctors are trained to recognise the symptoms of diabetes and are willing to refer the diabetes patients to the hospital, many diabetes complications may be detected before it is too late,” she says.

According to treating physician, Dr. Daniel Agbley, the patient Mr. Agbe Komla Ernest stayed in the ward in Ho Municipal Hospital for six weeks. Sugar control was good ranging between 3.6-6.2 mmol/dl. The wound was debrided and became clean with granulation tissue growing and there was no necessity for amputation. He was discharged because he wanted to go home to his family in Kumasi. Upon discharge, he was recommended to continue with the insulin, soak the leg in saline water every morning and dress with an antiseptic solution. – And to attend the local hospital for check up.

Read more about the project