11 August, 10:20pm GMT - Mole National Park, Dumango

Today, we drove to Mole National Park (pronounced Mol-eh) with the Friends volunteers, who are continuing on tomorrow to Tamale for a week long outreach, and their driver, Ernest. Our original plan was to spend the day in Kumasi visiting the internet cafe and market and to be driven up to the Park on Sunday by a Kate Memorial driver, but, as it turned out, the Friends van had room to carry us. Along the way, we discovered that had we stuck to the original plan, we may never had made it to Mole, as our driver (who we asked to pick us up on Sunday instead), called to tell us first that he didn't know how to get to Mole, then that he could only pick us up halfway there, then that he didn't have access to the van at all. Fortunately, Ernest contrived the ingenious plan to take us to Tamale with the Friends volunteers, then to send us on a bus back to Kumasi on Monday morning. Tonight, we are staying at the Catholic Guest House in Dumango 30 minutes outside the main entrance to the Park, which we were grateful to find has A/C and enough room for our mosquito nets. For dinner, we ate at Flemish Pop Restaurant (not sure where the name is from, though it featured neither Flemish food, Flemish soda, popular music, or Flemish popular music).

Dumango is seven hours northwest of Kumasi. The farther north we drove, the greater the proportion of Muslims, which first became obvious when we stopped at Falls Rest Area which featured a washing station and open-air mosque. As we drove the two hours along the road west off the main highway through the Park towards our hotel, the area turned from midsize towns of cement buildings with iron roofs we'd seen everywhere in Ghana thus far to small villages of mud huts with thatch roofs. The drive was along a dirt path with lush green plains on either side, termite mounds as stacked eight feet high beside low-hanging trees, and not a single piece of trash in sight.


From this trip and my previous training, I've learned a lot about international non-profits and their work. For instance, I've learned that NGOs should recruit health care workers from the community and volunteers from abroad and train them; subsidize equipment, salaries, and medical care; and communicate with local workers to monitor volunteer activity and program feedback. Working with local medical practitioners is important to reduce overhead, to improve the quality of care, and to reduce brain drain from the country. To do this, Unite for Sight sets up outreach clinics in rural areas. These rural clinics break down barriers to care, such as long distances to travel to clinics or high cost of treatment, by bringing the clinics to them at low cost. The goal is to help others help themselves by building up existing infrastructure while forming a partnership with the community.

Unite for Sight, from their experience and from studying the successes and failures of other international nonprofits, has developed a "gold standard" of practice for global health organizations. They suggest that such groups maximize the benefits of its effort by increasing:
      -     Access to Care: Eliminate barriers to care by providing transportation to and reduced cost for health care.
      -     Quality of Care: Develop long-term solutions to health problems, using education and preventative treatment instead of temporary relief of symptoms.
      -     Efficiency: Use a bottom-up approach, beginning by working directly with the community organizations, who do not have cultural or language barriers between themselves and the patient. Maintain low overhead. Only donate equipment requested by partner clinics.
      -     Accountability: Train all volunteers to be certain that only licensed medical professionals diagnose or treat patients. Be open to external evaluations to continually improve practices.
      -     Sustainability: Partner with local clinics to promote their own independence and to provide year-round care. Inspire and recruit others to volunteer.

To most effectively improve quality of life in these communities, Unite for Sight chose to treat and prevent blindness. Blindness exacerbates gender inequality, as women are more likely to have visual impairment due to exposure to infectious diseases through childcare, yet are also less likely to seek treatment in order to invest more in their families. Preventing or treating blindness is also cost-effective. When sight is restored, the individual is able to return to work and contribute to the family’s income. The economic impact of blindness extends to the family members of the blind individual as well, who may need to stop their job or education to become the caretaker of their blind family member, preventing an impoverished family from escaping the poverty cycle

From this experience, I earned a certificate in Global Health & Program Delivery from Unite for Sight’s Global Health University. If you are working for an international medical non-profit (hint hint Cindy) and want to learn more about good practices in global health delivery, such as how to train volunteers to be culturally sensitive and how to make your work sustainable in the long term, I would recommend reading the some of the material available for free at the university (you can also get a certificate in certain topics, but you have to pay $65 and summarize all the modules, which frankly isn’t worth it).

Although the reality of their model isn't perfect, and the care provided is nowhere near the care provided in the U.S. in terms of quality, it achieves an end successfully without cutting corners on the means. It's a good demonstration about how directly supporting a community by letting its members lead is an effective way to contribute to its future. I see the same effectiveness in microfinancing. Microfinancing also promotes gender equality, as most microfinance projects support women, who are more likely than men to repay their loans and are more likely to invest the profits of their venture in their family rather than on alcohol, tobacco, or entertainment. Microfinancing supports small businesses, which is how a large portion of the population is employed here. Since microfinancing allows people who need funding to to invest it directly into what they need, it works better than direct projects independent of the people like building a schoolhouse. I have passed more than one abandoned schoolhouse or library on the roads to villages before. Just because you build it does not mean they will come.

The best investment, I believe, is knowledge. We can share our knowledge via health innovations, such as low-cost medical technology or glasses that self-adjust to a prescription using water. We can also share our skills, training locals to use the materials we provide to build schoolhouses or treat a patient. Even better, we can use the materials available in the country to design a solution to a problem, then build the solution with the people, teaching them how to repair it with local supplies and how to build their own after we've left, an approach which Engineers Without Borders takes on their projects.

To simplify, imagine if a community has a problem with house roofs collapsing from branches falling on them. One approach would be to visit the community and remove all the branches, which relieves the symptoms of the problem but does not treat the underlying cause. Another approach is to donate ladders to the community, which helps them reach their own roofs, but the effectiveness of the solution is limited by the number of ladders you can afford to donate. A third approach is to build a ladder alongside each community member using the resources available to him, bringing your knowledge, time, and just enough funds to cover the costs he cannot afford himself. He can then reach his own roof, build ladders for others, and even teach others how to build ladders to reach their roofs.

This trip has forced me to reevalute my perspective of service as an act of compassion that deserves gratitude to an act of support to help others lift themselves up. I’ve come to learn that a frustrating experience is just an opportunity to expand my worldview.  In other words, where others might see a hole in the wall, I see a window.

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