Une longue route vers les soins de santé ruraux : les sœurs servent les villages éloignés du Ghana

Une longue route vers les soins de santé ruraux : les sœurs servent les villages éloignés du Ghana

Global Sisters Report (GSR) || Par Dana Wachter || 15 février 2018

De quatre minutes à 16 heures, Sr Mary Nyarko a quitté un grand camion, le mode de transport le plus luxueux pour elle ce jour-là, qui a commencé à 7 heures. Il a rendu la route boueuse cahoteuse de son trajet en ferry ponton au petit village où ses sœurs gèrent une clinique de santé rurale un peu plus supportable.

La clinique des Sœurs Missionnaires Saint-Esprit n'est pas loin de la maison de Nyarko à la capitale du Ghana, Accra, elle est loin de partout. Même les patients qui ont besoin de soins marchent souvent deux ou trois heures pour atteindre la clinique, ce qui signifie qu'ils peuvent être trop tard pour recevoir des soins médicaux pour les aider. Avec des ressources et des effectifs limités, les trois sœurs qui dirigent l'établissement ont les mains pleines et les jours chargés de servir au moins 1 000 patients par mois.

La clinique a été créée dans le cadre de la mission de la congrégation « poursuivre le ministère de guérison du Christ », a déclaré l'administrateur de la clinique, Sr Mary Nkrumah. Initialement, des sœurs d'Allemagne et des États-Unis étaient venues comme missionnaires au Ghana en 1946 et des années plus tard ont cherché des zones isolées pour s'occuper de ceux qui étaient loin des soins médicaux établis.

« La plupart des gens d'ici [étaient] mourants de morsures de serpent, d'autres mourants lorsqu'ils livrent [des bébés], d'autres aussi avaient toutes sortes d'autres maladies. Les gens n'étaient pas vraiment pris en charge », a déclaré Nkrumah.

Il n'y avait même pas de routes pour amener les patients dans les établissements de santé, alors Nkrumah a dit que les sœurs sont allées vers le peuple.

Après la création d'hôpitaux dans des villes comme Nkrawkraw, les sœurs ont d'abord basé leurs missions éloignées d'une ville appelée Donkor Krom, la capitale du district d'Afram Plains. De petits villages de quelques maisons une ligne de routes boueuses; ils ont une culture à petite échelle et élever des poulets, et dans les régions du lac Volta, les gens capturent et fument du poisson. En tant que sœur pendant 25 ans, Nyarko a passé du temps à travailler au centre de santé de Nkrawkraw et connaît bien les sœurs qui travaillaient dans les zones rurales. Elle a décrit les sœurs qui faisaient des voyages quotidiens dans des villages isolés et a trouvé impossible pour beaucoup d'entre elles de faire le voyage de retour le même jour. Ils ont vu la région près de Kwesi Fante particulièrement négligée. Dans les zones où il n'y avait pas de routes du tout, Nyarko a dit que les sœurs ont parlé avec les chefs locaux pour obtenir un logement pendant quelques jours à la fois. Bientôt, la collectivité a construit une petite structure en briques pour l'hébergement et la clinique a été lancée à la fin des années 1990.

"À Donkor Krom, il y a un hôpital là-bas, donc au moins ils peuvent gérer," dit Nyarko. "Mais cet endroit, rien. C'est ainsi que Kwesi Fante a commencé."

La longue randonnée vers le village

Le voyage de Nyarko de Accra à Kwesi Fante a pris environ neuf heures, la plupart utilisant les transports en commun. En voiture privée, il faudrait environ 5. S'arrêtant dans plusieurs villes via Tro Tro (passager van), taxi partagé et un ponton de ferry, Nyarko essaie d'aller à la clinique tous les deux mois, ou quand le besoin de prendre soin des affaires administratives se fait sentir. Après 28 ans dans la congrégation, dont 14 dans le pays voisin, le Togo, Nyarko coordonne maintenant les activités de mission sous la direction des Sœurs Missionnaires Saint-Esprit au Ghana.

"C'est toujours mieux quand vous avez votre propre voiture," Nyarko a mentionné le camion de ramassage blanc Toyota Helix que Nkrumah et leur chauffeur sont arrivés au port du ponton sur le lac Volta. C'était encore 45 minutes avant son arrivée.

Nyarko décrit Kwesi Fante comme un sous-district; environ 61 000 personnes y vivent et dans les villages environnants, dit-elle. C'est un village si petit qu'il n'est pas listé sur listes en ligne de la population ghanéenne. En revanche, Accra compte près de 1,6 million de personnes.

The clinic itself is separated by walls within the village; there is land for more buildings, but funding makes it difficult to expand accommodation or healthcare facilities. Without consistent internet and cell service, the Mother Josepha Convent runs with a water tank and solar power lights when electricity inevitably goes out. The clinic is a couple dozen meters from the convent, in the same gated compound. There may be assigned government-appointed medical staff, but it’s hard to retain qualified workers after their mandatory national service is up.

Arriving at the convent by 4 p.m., Nyarko dropped her small travel bag in her guest room and joined her colleagues for lunch. The others had already eaten, but they saved Palava sauce, made with kontumbre (a Ghanaian vegetable similar to collard greens), rice, boiled yam and plantain, for whenever she would arrive.

Three sisters live at the convent now: Nkrumah, the administrator; Sr. Eunice Tamea who runs the pharmacy, and Sr. Petra Manalo who is a midwife. They work with nurses on site, some community health nurses who visit villages in the region, medical assistants, pharmacy assistants, one other midwife, and lab technicians.

Life at the clinic

Returning from checking on a mother in her maternity ward, Manalo joined Nyarko and the others at the dining table. She had been up all night, delivering the baby of a woman who has HIV.

“We are only two [working in the ward]. So, most of us, we take a double shift. And you know, [we are] always ready when they call us to help them. Sometimes we don’t have time for ourselves,” Manalo said holding back tears.

She faced a big learning curve getting used to this small community she joined just a few months earlier. She came to Ghana three years ago from her home in Indonesia, as a Holy Spirit Missionary Sister. Manalo first needed to study English, and then get re-certified in midwifery in her new country.

Working without oxygen to help mothers delivering babies, Manalo says they try their best, but she struggles knowing that they often are not able to make it to the nearest hospital, which is at least two hours away on unpaved roads. She sees mothers who arrive with nothing, who can’t afford the trip to the hospital anyway.

Many patients can’t afford to pay for services, though the sisters are patient in waiting for payment from those who can. Regardless of anyone’s ability to pay, the sisters offer care. “We come here, [and try to] save the life. We have only faith, and we have mission and vision to save the life. Just that one,” said Manalo.

Through the window of the laboratory are thatched roofs of the villagers. Most live in huts made of mud, with straw and branches arranged on top.

Nkrumah explained that villages like Kwesi Fante, consisting of 10 to 20 homes, typically lack electricity, internet or cell network services, decent roads, and even water. Because there are few amenities, she says, it’s hard to find qualified staff willing to stay here.

Recently, one medical assistant who said he was going to visit his family never returned. Nkrumah feels the need to build better accommodation for the clinic staff, to entice them to stay, but that takes funding that the sisters don’t have.

Challenges in the village

“It’s very difficult for somebody to be in the village for almost 18 years,” said Amatus Arko, the clinic’s microscopist.

He knows he’s unusual in that he’s worked with the sisters for all these “good years,” as he calls them. His family lives four or five hours away in the city of Kumasi, where he says his children can receive a better education. He travels to see them some weekends, and they stay with him in Kwesi Fante during school vacations. He admits that it’s difficult but not unusual for fathers to live away from their families in Ghana.

Originally from Sunyani, about a seven hours’ drive away, Nkrumah moved to Kwesi Fante about a year ago. She joined the sisters in 1993, professing in 1997 before teaching in Ghana and eventually spent four years in social pastoral work on a South African mission. After working in a Holy Spirit Sisters’ hospital a couple hours from Kwesi Fante and returning to school to study public health, Nkrumah arrived in Kwesi Fante about a year ago and realized how much the clinic needs her leadership.

While their services are appreciated, Nkrumah knows if they could create more of a hospital atmosphere, with an accredited doctor, surgery theater, and proper outpatient department, their patients would be better served.

“We have medical assistants; they have also their limits,” said Nkrumah.

Lab technician, Aboo Thomas arrived only a year earlier, too, from Ghana’s Upper West region. He explains the manual blood cell counting processes used to diagnose malaria, sickle cell disease, and tuberculosis. One out of 10 patients here typically has malaria, so Thomas calls their area “endemic,” yet his process is only an estimation since they don’t have hematology analyzers to count specific cells.

When the facility first opened, Nkrumah says they had fewer than 200 clients a month because people were afraid they would be referred elsewhere, meaning the long trip would be for naught. Now, she explained, they at least know they’ll likely get drugs for their ailments, but her staff struggles to provide emergency care.

“For instance, the road now, because of the rains, it is totally out of use. So, we take [patients] to Donkor Krom; [it takes] about three hours before we get there,” Nkrumah described. And when we go to Nkrawkraw, you have to also only [wait] at the ferry, [often] for more than two hours, before we can cross.”

Since they can’t perform transfusions or offer high-tech solutions, the sisters need to refer sick patients and pregnant women facing complications to a bigger health facility. Nkrumah knows even their ambulance isn’t quick enough to help those referred patients.

“If the case comes, and it’s already in a bad state, before you get to the hospital, the person is gone,” said Nkrumah.

Knowing it’s not always possible for positive outcomes, the sisters and their nurses work toward preventative care. They sustain outreach programs, making their way by truck through woods along unpaved roads to visit communities and offer vaccines or medical advice.

Nkrumah, though, isn’t deterred.

“I’m happy to be here because the people need us,” she said. “Sometimes you get there, there’s no road — you have to create the road for yourself. …It’s a kind of joy, you know.”

[Dana Wachter is a freelance journalist and digital storyteller based in London, Ontario.]

Source: Global Sisters Report...