Windows into Kumasi, Ghana: Women’s Health to Wealth

Several years ago, under Columbia University’s Millennium Cities Initiative (MCI), then-Kumasi Project Manager Abenaa Akuamoa-Boateng, rented two adjacent market stalls in the middle of the second largest market in Kumasi, Ghana’s second largest city. There, positioned between the giant yams and onions, plastic goods sellers and shoemaker, Abenaa established the Bantama Market Clinic, to provide the female market vendors who feed Kumasi every day with the clinical services they otherwise have no time to access, given that they leave their villages before dawn to be in town in time to catch the morning shoppers. Once a woman has been screened at the Bantama clinic – for hypertension, diabetic or pre-diabetic conditions, cervical and breast cancer – the clinic retains her electronic medical record, so that she can be referred to specialists as needed and checked up on by public health nurses, to make sure she returns for follow-up appointments.

Each woman’s initial screening qualifies her to participate in savings and Social Capital Credits (SoCCs) programs, also initiated under MCI and, like the market clinic, led since November by Women’s Health to Wealth (WHW), a Ghanaian NGO Abenaa set up in partnership with WomenStrong International (WSI), to continue and expand her previous work, so that care would not be interrupted for these hundreds of brave women who, of necessity, put the city’s food supply above their own families and personal health. The women love the increased earnings from the savings and SoCCs programs, which have enabled them to pay a daughter’s school fees, purchase more nutritious foods for their families or upgrade their market stalls. As a community of vendors, they can also trade their collective “social capital credits,” reflecting their accumulated performance of community service activities to which the women themselves have accorded specific convertible values, to put up street lights, making the market area safer after dark, or to pave the market’s dirt alleyways, to prevent the flooding and muddiness that deters customers during the rainy season.

WHW uses the vendors’ Savings and SoCCs Group sessions as opportunities for the public health nurses at the clinic, Abenaa and her team to impart vital health, nutrition and hygiene information to the women. The same team produces WHW’s weekly FM community radio programs, which are broadcast throughout the Bantama Market, focusing on one or another critical health issue and enabling the women to share their own experiences, both at the clinic and in their savings and SoCCs groups, with their peers.

Women’s Health to Wealth also works with adolescent girls, both in the Bantama sub-Metro and in other Kumasi public schools, through a Girls’ Club program begun under MCI, in partnership with the US non-profit LitWorld and the Ghana Education Service. Now managed by WHW and WomenStrong, the Girls’ Clubs continue to operate in the same schools, with the aims of strengthening girls’ literacy, confidence, advocacy skills and their desire to continue their education.

But this already ambitious program didn’t go far enough. As soon as Abenaa began working with the Bantama Market women, she began thinking about the challenges in their lives and in the lives of their families, as they struggle to thrive in their farming villages, all around the edges of Kumasi.

You see them every day — these beautiful, colorfully dressed women, their strong, weathered faces and muscular arms, bringing and selling their fresh food to Kumasi City residents. But what about their small children, Abenaa wondered, whose mothers might have to roust them out of bed each night, dropping them at a relative’s or neighbor’s on their way to the city? Who minds these kids? When do they get to go to the clinic?

And what about the adolescent girls at Kumasi’s periphery? With their mothers gone all day, how strong is their school attendance, at their hard-strapped village schools with no toilets and few mentors? Shouldn’t there also be Girls’ Clubs in these areas, to help keep the girls in school and give them the courage and appetite to continue their studies? Abenaa had heard there are also many who are not in school – how to reach these girls?

In fact, Abenaa founded WHW to answer precisely these questions – questions that don’t appear at first glance, even after repeated immersion, because the challenges are masked in the invisibility of this population whose mothers keep Kumasi nourished. Indeed, as is the case everywhere, this invisibility is a major part of the challenge: when a problem isn’t seen, known or reported in ways that make news, it is likely to persist untouched. After all, there is always plenty to address that is known – other pressing issues that powerful people are making noise about — and anyway, what local administrator or politician needs one more inconvenient humanitarian crisis to attend to?

So with WomenStrong’s support, Women’s Health to Wealth bought itself a vehicle, hired a team and, again in partnership with the Ghana Health Service, began operating mobile clinics that now offer the same array of women’s health screenings, Savings and SoCCs Groups and other services to the women and girls in their own home communities as are now available in the Bantama Market.

WHW quickly initiated Girls’ Clubs at the schools in these communities, and in early July, together with the Education and Health Services and Marie Stopes International, organized the first in a series of Adolescent Reproductive Health Fora, with the tag line, “Be a Strong Girl: Know the Facts!” In a remarkably frank open session, some 340 girls listened to public health officials as they spoke about menstruation, family planning, safe sex and the importance of feeling good about oneself and continuing with one’s education, as the best way of exerting and ensuring lifelong control over their own bodies and minds. Girls had the opportunity to ask questions, both of the panel of experts and, as desired, in one-on-one sessions. The girls seemed excited about the forum, with 21 signing up to be trained as “peer educators” who will anchor the school’s new Girls’ Club when school opens. A second Adolescent Reproductive Health Forum will also take place early in the term, spreading vitally important health and hygiene information to hundreds of girls in yet another peri-urban school.

So mobile clinics, mobile sex ed, family planning, personal counseling and identifying of at-risk girls in these sub-urban schools – all part of Abenaa’s vision, in founding WHW. But what about those girls NOT in school?

Almost as soon as the mobile clinics began making the rounds of these neighboring villages, Abenaa discovered that indeed, there are many out-of-school girls here who, with few earning opportunities available to them there, have taken to dressing up at night, heading to downtown Kumasi on a tro-tro (the ubiquitous privately operated van taxis by which ordinary Ghanaians get around) and working the streets. These middle school-aged sex workers return home only near dawn, maybe in time to be back in bed before their mothers know they’re missing, busy as these women are, wrapping and hoisting their fresh produce, eggs and chickens so that they stay fresh and are properly secured for the long trip to the Bantama Market.

Because of WHW’s successful entry into these “edge” communities via the mobile clinic, Girls’ Clubs and Adolescent Reproductive Health Forum, Abenaa has earned sufficient trust to be able to set up focus groups for some of these girls. Each of the three sessions to-date opened by asking the girls to consider the following questions:

1. Why are you not in school?
2. What, in your mind, are the characteristics defining a successful girl and woman, and why?
3. How do you plan to become like these successful girls and women?

The girls jotted down their responses and then continued with animated group discussions. The next step, Abenaa says, is for each group of girls to sit together again, synthesizing their answers and deciding together on a plan of action that can help them achieve those images of successful girls and women. Once the girls can see the disconnects between their current lives and their aspirations, Abenaa hopes that, with support from WHW, WomenStrong and the network of partners she has enlisted, they may be motivated to change the behaviors that, although they may seem effective in the short-term (at least as far as income-generation goes), may be stressful, self-destructive or even traumatic and might actually be diverting them from realizing their longer-term goals.

This work, of course, is exquisitely delicate; it takes time, patience and constancy, all qualities that define WHW as an organization taking on the unseen, chronic crises facing the women and girls of Kumasi and its surrounds.

With her attention focused on Kumasi’s periphery, Abenaa has been able to count on the Bantama clinic as running smoothly, with little cause for concern. Recently, though, the Bantama women have begun bringing their children and other family members to be seen at the tiny Bantama clinic, which was set up only to do health screenings for the local vendors. But with Ghana’s severe economic crisis triggering rolling strikes among medical practitioners, and the country’s once-celebrated National Health Insurance Program reportedly near bankruptcy and unable to reimburse most medical consultations, procedures and medications, the market women have only WHW’s trusted clinic to turn to, when their children are sick, or for guidance regarding appropriate care for an ailing husband or elder.

As the invisible humanitarian crises multiply, Abenaa has her work cut out for her. One woman’s vision — saving the families of those who bring sustenance to the once-celebrated “Garden City” of Kumasi: it’s not enough, but it’s more than anyone else has done, and it’s a strong start.