Africa: A Practical Guide for Global Health Workers

4: Ghana

63 ghana x Ghana has enjoyed relative stability since this West African country first became independent in 1957. This geopolitical stability, coupled with a rich history and a reputation as a friendly nation, make Ghana a favorite destination for volunteer groups and global health workers. Many international agencies and nongovernmental organizations (ngos; see the glossary) have offices and a sizable presence of aid workers in the country . Ghana enjoys the distinction of being the first country in the world to accept Peace Corp volunteers, and its program has remained one of the largest. Over the decades, U.S. volunteers have been involved with programs in education, agriculture, business, health, water sanitation, and youth empowerment and education. Many U.S.-based schools and universities have established exchanges with counterpart institutions in Ghana, so students at all levels of training participate in study abroad or exchange programs in the country. In addition, a growing number of churches from around the world have established regular medical missions to Ghana, typically in collaboration with “sister” churches in Ghana. These medical missions offer their congregants the opportunity to make a difference through volunteerism. Not surprisingly, then, there is a growing demand for practical resources that can serve as part of an orientation for the health worker preparing to go to Ghana. This chapter provides a brief history of Ghana from its earliest days of settlement, to the colonial era when Ghana was referred to as the Gold Coast, and its struggle for independence. Then we discuss current geopolitical and socioeconomic trends in the country, its educational and joyce a. sackey nameeta m. dookeran stella safo 64 africa : a practical guide health systems, and important cultural, health, and other contextual considerations that should inform the work of any health professional or volunteer seeking to successfully implement a community development project, engage in research, or provide direct patient care in Ghana. History and Geography Ghana is a small nation (239,460 square kilometers, or 92,456 square miles) in West Africa, surrounded in the south by the Atlantic Ocean and in the north, east, and west by the Francophone countries of Burkina Faso, Togo, and the Côte d’Ivoire, respectively. Ghana’s three ecological zones—savannas, coastal lands, and tropical rainforests—and alternating wet and dry seasonal changes have made it both rich in natural resources, like cocoa and gold, and replete with such tropical diseases as yellow fever and malaria. Present-day Ghana was settled by hunter-gatherer groups as far back as the Stone Age, some 50,000 years ago. The ancestors of contemporary ethnic groups such as the Akan and the Ga-Dangme began settling in the region around 2000 bce. Early archaeological records show that many of these groups emigrated from surrounding West African territories —the current countries of Nigeria, Togo, and Benin. Once settled , pre-colonial Ghana flourished as several autonomous and often conflicting tribal nations. The northern ethnic groups were the first to form centralized states in the seventeenth century under Islamic rule. The south, home to the Akan ethnic group, was ruled by the powerful Asante tribe that wielded political and military power over the region through the formation of the Asante Confederacy in the eighteenth century . The tenuous balance of power shared by Ghana’s pre-colonial ethnic states would be greatly disturbed by the entrance of Europeans in the fifteenth century. Ghana’s natural resources and its coastal location made it a longcoveted prize during the centuries of European exploration and colonization of the African mainland. The Portuguese were the first Europeans to settle along Ghana’s coast, in 1471. They built coastal forts, as did the Dutch who came to Ghana in the late sixteenth century. These early forts would become the slave castles from which human, manufactured , and natural resources from the heartland of Africa were shipped to other parts of the world. ghana 65 However, it was the British who had the most lasting impact. British merchants could be found in Ghana as early as 1631. Like other Europeans , the British settled along the coast and accessed Ghana’s wealth of natural resources by interfacing with the chiefs and traditional leaders of local tribes. Since the Asante were the most powerful ethnic group, the British were forced to abide by their rules and whims in order to gain access to important trade routes and resources. It was not long before British merchants...