April 26, 2013
April 26, 2013
The ratio of doctors serving the population of the rural Upper East region is just one for every 35,010 citizens.
ACCRA, GHANA – When residents leave the rural Upper East region for a new life in one of Ghana’s cities, they rarely return. So Cephas Ke-on Avoka, a 22-year-old medical student from the region, has astonished villagers by returning to work in Garu, the village where he was born.
Avoka cannot imagine working anywhere else, he says.
"I have always been passionate about working in the community – to serve, to help the helpless, put smiles on the faces of sick people who can't readily access health care," he says in a video interview from his university in Kumasi, a city in central Ghana, where he is preparing for examinations.
Born in Garu, Avoka grew up in Bolgatanga, the tiny capital of the Upper East region, where the majority of the population works as farmers. He left the region to pursue his dream of becoming a pediatric surgeon.
Avoka is now a fourth-year medical student at the Kwame Nkrumah University of Science and Technology. When he graduates in 2015, he will have employment opportunities in urban hospitals or abroad for a higher salary, routes his peers usually take.
But he says that his first responsibility is to the rural areas of his childhood. After extensive periods of volunteering in the village of his birth, he plans to continue his investment in Garu after graduating.
Doctors in Ghana’s rural areas do not earn much, and a government-run hospital would provide better compensation. But he says the smiles of his patients are the best remuneration.
"A simple, 'God bless you,' for me, is more than any amount that any government can pay me," he says.
Ghana is undergoing rapid urbanization, according to the Ghana Population Stabilisation Report published in 2011 by the National Population Council. Young adults, especially, “are compelled to migrate from rural to the urban areas to seek better job and other opportunities,” according to the report.
Urban migration has hurt the health sector in Ghana’s rural regions. The majority of Ghana’s doctors practice in the Greater Accra and Ashanti regions, home to the urban hubs of Accra and Kumasi, according to a 2010 report by the Ministry of Health titled “The Health Sector in Ghana: Facts and Figures.”
By comparison, only 29 doctors served the entire Upper East region in 2009, according to the report. This translated to a ratio of one doctor for every 35,010 people.
During Avoka’s third year of medical school, his uncle, a doctor, invited him to return to Garu to lend a hand at the Quality Medical Centre, a small clinic he owns in the village.
"I was very enthusiastic about it!" Avoka says.
He had not spent an extended period in the village for 20 years and was excited at the opportunity to reconnect with the people of Garu.
What followed was the most stressful three weeks of his nascent medical experience, he says. But it was also the most memorable.
Avoka worked with his uncle and a medical officer from 8 a.m. to 10 p.m. each day, struggling to provide adequate care despite a shortage of resources at the clinic.
A woman once brought her son to the clinic with a suspicion that the boy was developing a tumor, Avoka says. But the clinic did not have an X-ray machine or other vital diagnostic equipment, so they had to refer the mother and her son to the Komfo Anokye Teaching Hospital in the Ashanti region, a 10-hour drive from Garu.
Now, whenever Avoka takes a break from his studies to return to his work in the village, he takes a moment to stand in front of the clinic and reflect on the work that lies ahead to develop his community. But he says it is work that he is happy to perform, especially in his “sparkling white coat.”
"I love to help these people,” he says, smiling. “I love to be called ‘Doctor.’ I enjoy so much listening to and interacting with patients about their conditions."
Justice Jambeidu, the general administrator at the Quality Medical Centre, says the village is equally grateful for Avoka’s past and continuing commitment.
“I think the work he did here has gone a long way to improve the health care delivery in the community,” Jambeidu says in a phone interview from Garu. “It is very difficult to get the requisite professional staff here. The issue is so appalling.”
It is infrequent that medical students or doctors choose to come to rural areas such as Garu, he says.
“It has become a common phenomenon that all the professional staff want to work in the city,” Jambeidu says. “It definitely is unusual that a young man like Ke-on would want to work here, rather than in the city.”
Lucy Donaldson, a social worker and nurse in Accra, the nation’s capital, spent six years as a community health nurse in rural Ghana. Doctors need high levels of commitment to handle the lack of infrastructure in these areas, she says in a phone interview.
"What drives most health providers away is the availability of very little resources and logistics," she says. "Going [a]round a community each day is very tiring. It gets worse because you don't have a car, and the sun won't spare you.”
Doctors in these areas must also fight cultural norms, she says. In some areas, women need permission from their husbands to obtain medical care, or community members reject medical care in favor of spiritual beliefs.
“It makes the work very difficult,” she says.
Jambeidu says Avoka’s passion in spite of these obstacles is what sets him apart from his medical school colleagues.
“Working in a rural area in itself is a great sacrifice,” Jambeidu says. “You can’t imagine someone in his age group leaving his friends and all forms of socialization to come to a place like Garu, where there is no place to hang out.”
Typically, medical students will visit Ghana’s rural regions only if their program of study requires it, he says.
Avoka says that encouraging his colleagues to work in areas with the highest need is a big goal of his. As an executive member of the Federation of Ghana Medical Students Association, he has tried to persuade his fellow medical students to follow his example.
"Not every executive member or medical student is passionate about working in rural communities," he says.
But this does not discourage him from fostering interest in rural development.
"I haven't given up anyway,” he says. “When I complete medical school, I will work very hard to ignite this passion in the federation."
In the meantime, Avoka continues to invest in his rural community. He is currently collaborating with Plight of the Child International, an organization that focuses on children’s welfare in Ghana, to raise funds that will support medical interns in Garu. He also arranges free medical consultations, testing procedures and health screenings in several villages through this partnership.
His long-term plan for development in Garu is to establish schools and hospitals that will provide affordable education and quality health care to the people in the community.
Investing in Ghana’s villages is the only way to secure the country’s future, he says.
"I am a strong advocate for the provision of quality education and health facilities to every community,” he says. “This, I believe, will serve as a building block to development and sustainability."