Today, the International Health and Development Network Clinic stands with its outer shell shiny and newly completed as well as much of its interior alive and bustling. There are six exam rooms with the wiring in place for the day when computers and electronic medical records arrive. There are ten inpatient beds ready to provide comfort for those who require extended stays and around the clock care. There are a treatment and procedure rooms where emergencies are tended to, as well as a laboratory capable of running basic blood work and microscopy, and a pharmacy with a decent inventory of medications.
Yet parts of the three story building continue to evolve. A radiology room is awaiting a functional x-ray machine and lead panels for its walls, and the operating theater is being retiled with some alterations to the floor plan. Two apartments on the second floor are near completion, waiting to shelter any in-house staff, who would need to stay overnight to watch over inpatients, and several potential offices await administrative staff. The two rooms on the third floor are emptied pending the arrival of radio broadcasting equipment to produce public health awareness segments for the village to tune in to.
Beyond the burgeoning growth going on inside the clinic itself, the grounds upon which it is situated are also in a state of flux. The land was purchased with a much larger development plan in mind. At some point, inpatient wards will be built, a nursing education building will join, living quarters for the medical staff and even an on site morgue will spring up. Aside from architectural contributions, plans for small cassava producing fields, a fish farming pond, and a community water tower providing clean water are also in the works.
Now that a commanding, impressive, tangible product has resulted from thirteen long years of Dr. Agamah's toils in his home village of Agbozume , Ghana , villagers are beginning to express some confidence and trust in the grand endeavor. When motor bikes crash or when lacerations are suffered, the patients come into the clinic to get stitched up. When children become severely dehydrated and febrile from intractable diarrhea and vomiting, the parents bring them into the clinic to receive medication and supportive care. There are also some regulars who have slowly but surely accepted the implications and responsibility of a chronic condition like hypertension or diabetes and regularly visit for checkups and refills of their medication.
Nonetheless, there are still imposing obstacles to caring for the patient population. A National Health Insurance Scheme is in place and operational which provides an excellent safety net for the poorest people in the country. However, the IHDN clinic is a fairly new institution and has yet to be evaluated and accredited as a legitimate center for health care provision by the government. After the December elections, an entirely new administration came into place, which had failed to appoint a new Health Administrator during our trip. Three years ago I grew accustomed to seeing fifty patients in a day come to see Dr. Agamah in the makeshift clinic in his parents' house; whereas this time, only about twenty per day came to the newly constructed full fledged clinic.
More than just governmental obstacles stood in the way to efficient continuity of care for our patient population. In light of increasing prices of food, decreasing production and a quickly expanding population of now more than twenty-two million, hunger is widespread and incomes and personal wealth remain largely meager. Every five days was Market Day in Agbozume which ultimately meant that practically no one would come to clinic that day. The duty to either man a booth and attempt to scratch out a living all day or search the market for food and basic sundries for the family outweighed the duty to personal health. Knowing when these days occurred and scheduling follow ups around them was easy enough, but no amount of scheduling could solve the dilemma between spending one's little earnings on food versus life-preserving medication.
While the lesser advantaged faced their own quandaries of delegation of resources, some of the more privileged displayed surprising amounts of entitlement. Part of each of Dr. Agamah's visits back to Ghana involve a certain degree of what he labels “politicking”. There are still a healthy handful of local tribal chiefs throughout the region, each of whom still cling to an image of commanding power. Despite faithful visits to each chief, attempting to include them in the growth of his dream, and encouraging them to take an interest in the welfare of their people, Dr. Agamah still faces veiled degrees of contempt from these men. They claim that he is absent the majority of the year and that the location of his clinic (not necessarily in their particular neck of the woods) is an affront.
Not only do the tribal chiefs show their contention, however. A donation of a cardiac monitor to the teaching hospital's Department of Cardio-Thoracic Surgery was met with disdain by the heads of the Department of Medicine. These were the same doctors who months earlier turned down the donation of dialysis machines shipped from the United States with Dr. Agamah's own money, and the same doctors who did not attend the opening ceremony of the IHDN clinic in the spring of 2008.
One of the reiterating frustrations is wondering where to start in all this. You could start by knowing that hundreds of years of problems have existed. It's true: colonialism, slave trade, agricultural productivity, missionary pervasiveness with religious strife. It seems pretty easy to come here, recognize a plight, assess the odds against you and put your shoulder into it anyway while maintaining a smugness for being so pure and disadvantaged all the while knowing you can leave. The question of sustainability and charity eventually becomes demanded. You have to know that you yourself cannot change Africa . Africans are the only ones that can do this. As human beings we have to do out part to get them the resources we have, to share from our inequitable surplus, to give not only material resources or money, but of our very selves.
The nature of service is gift of self without idealizing your effect on the world. As soon as you realize that you are nothing compared to the work that needs to be done you can give up trying to see your results and just continue to work with what you can until your steam runs out; and it runs out. Charity is not what we make it to be. If you're giving out of pity it's just different. Consider what you're doing as an investment in the world. Acknowledge them as people, people with dignity. This is the most important thing you can really do: to show them they have dignity and deserve respect.
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