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‘Assin Australia’ the pregnant woman’s death sentence

The Assin Awisam CHPS CompoundSome said it was impossible, given the rains. Many warned it would be tough. Others simply laughed at my apparently naive request about the shortest and easiest route to get to Assin Awisam.

“It’s not easy, dear. You need to save this trip for last, and you need to have a lot of strength for it,” many advised.   

Assin Awisam is a small village in the Assin North Municipal District in the Central Region. It is fondly named by many within the district as “Assin Australia,” because it is so vastly separated from other towns within the district, with no direct road networks.

I was trying to get to Awisam to conduct research on referral systems for pregnant women within the district, under the auspices of Project Fives Alive!, a project working to reduce morbidity and mortality among pregnant women and children less than five years old in Ghana. I had all my interview tools ready; the challenge was how to get to Ghana’s very own Australia.

From Assin Fosu, the district capital, I waited for about an hour for the “trotro” (local bus) to fill up, and then took a gruelling two-and-a-half-hour ride to Twifo Praso on roads in such terrible conditions that at the end, you feel you have been given a rather rough, unsolicited workout.

After an additional 30-minutes wait at Twifo Praso, I went through another two-hour ride on roads in worser conditions than the first. This road is in such an exceptionally bad state that when it rains, the village is essentially cut off from the rest of the district for two to three days because of the mini-lakes that form on the roads. It did not help that I was scrunched in the backseat with three other passengers in a section meant for three, because the drivers like to maximise the revenue from each trip.

More than six hours after departure, I finally reached my destination, exhausted, dusty, and certainly not in the mood to conduct research. Why do I go through such excessive detail about a relatively mundane part of life in rural, and dare I say many parts of urban Ghana?

True, this experience at face value may strike some as unremarkable. However, its implications for general and obstetric referrals from Awisam are deeply troubling. If a healthy person like me felt so much discomfort trying to get to Awisam, how much harder would it be for a pregnant woman or a sick patient who needs to be referred from one health facility to another? What if the referred condition was an emergency and needed timely intervention?

In Assin Awisam, as in other parts of rural Ghana, there is a Community-Based Health Planning and Services (CHPS) compound tasked with providing care to this community. A big challenge for the CHPS establishment in Awisam is that the compound is located on the outskirts of the village right next to the cemetery.

There are not even streetlights lining the road from the village to the facility. Based on conversations with one of the nurses at the facility, several people within the town feel uneasy about going to the facility, especially at night since its proximity to the cemetery quite literally brings them closer to death. However, many others still visit the facility for their health needs, and when they do, they demand the nurses to try harder when they have to be referred, and often resort to traditional alternatives because the last thing they want to do is to make the dreaded, and often expensive, trip to the district hospital.

Despite this rather grim outlook, it is not all doom and gloom for Assin Awisam. In the Central Region, the Ghana Health Service has negotiated an agreement with several local transport unions to transport pregnant women needing referrals free of charge. In return, they are given a coupon, and drivers with larger numbers of coupons are periodically awarded prizes. Unfortunately, this initiative has not reached Awisam, making it imperative that such a deal be at least discussed with the local transport union there.

The National Ambulance Service has also been very recently introduced to the district, and even though it has not been used by the Awisam community yet, it holds tremendous promise for saving lives of referred women and children within the district. Fixing an entire referral system is not easy, but it is not impossible. It will require sustained partnerships from all key stakeholders in the referral framework, especially from the community level.  Seeing the struggles of many in “Assin Australia” and other remote parts of rural Ghana, it is high time we take a closer look at this important part of our healthcare system.   

By Henrietta Afari/Daily Graphic/Ghana
The writer is a student intern from the Harvard Medical School


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