Heat, hope & health workers

I felt the heat before I saw Ida’s smiling face… The heat lay like a blanket, draped over the rural setting that encircled me, including goats, chickens, wooden animal pens, mud-walled compounds, toiling farmers, and stooped agricultural workers. Ida wore a bright yellow, “Volunteers Engaged in Gender-Sensitive Technical Solutions” (VETS) program t-shirt, a lively headwrap, and a shy smile.

I had traveled to Bolgatanga in the Upper East Region of Ghana which scatters its primarily rural population in dispersed settlements under a hot, semi-arid climate. With only 20% of the population living in urban areas, the region is the least urbanized nation-wide and farming is the main occupation. In fact, the Upper East is a sprawling area with more than 1.3 million people and 3.3 million livestock. Despite the prevalence of livestock and farming, there are only 6 licensed veterinarians to serve the entire region, each with 8 to 10 Animal Health Officers. This means that there are just 54 to 66 individuals serving animal health needs in Ghana’s northeast.

Not surprisingly then, this is one of the primary locations that Veterinarians Without Borders (VWB) is currently operating its VETS program – an animal health, gender equity, and sustainable livelihoods program that spans 6 countries across Africa and Asia.

Specifically, I had traveled to Bolgatanga to visit VWB’s local VETS partner – the Ghana Poultry Network (GAPNET) – and document the incredible work that has been ongoing in the region since 2021 to train and implement Community Animal Health Workers (CAHWs). These frontline workers play a crucial role in delivering animal health services to the community, ultimately benefiting small-scale farmers and their livestock. Given the shortage of veterinarians across the country’s Upper East, it is immediately apparent that trained CAHWs, both male and female, are filling an essential and urgent need – safeguarding animal health, preventing zoonoses, and ensuring the holistic health of animals, people, and environment (i.e., One Health). To date, GAPNET has trained 41 CAHWs across the Upper East Region, 34 of which are women.

On this particular day, I was smiling and sweating alongside Ida Achatowe and Clement Afuo in Kologo Community – both were trained as CAHWs in 2021 and are currently the only 2 CAHWs serving the entire area. In fact, Kologo has only 1 veterinarian, Gilbert Asago, who is responsible for 3 neighbouring communities as well (i.e., Zuo, Biu, and Tampola), none of which have CAHWs. Gilbert explained that he receives one to two calls from each of his communities every week, so he is constantly traveling between them: “This is what makes Ida and Clement so valuable. There are many procedures that do not require a fully trained veterinarian, and which can be readily handled by a CAHW. They can care for wounds, perform vaccinations and deworming, and assess illness. Ida and Clement call me only when it is truly needed. So, an increase in animal health workers across my communities – and even across Ghana – would go a long way to improving animal health.”

Despite the heat, Ida and Clement spent several hours generously walking me through numerous nearby farms and demonstrating their CAHW skills in vaccinations, tic bathing, and wound care. For example, they treated a goat with an open wound on its backside – cleaning it and applying a topical antibiotic. Ida explained, “This sore was maybe from a scratch or the removal of a tic. It’s simple to treat, but the problem is that farmers often don’t know they should worry about or report a wound on their animals. Something small can quickly become serious and infected, or even kill an animal.”

Using an umbrella to shade me from the sweltering sun, we stopped at another farm to assess a baby goat. The farmer, 70-year-old Ameliba, had reached out to Ida because of the goat’s persistent diarrhea. Clement and Ida both quickly responded, pulling out their mobile phones and using the Food and Agriculture Organization (FAO) Event Mobile Application (EMA-i), with which all trained CAHWs are equipped. This national animal disease surveillance and reporting system enables field workers to report concerns in real time and obtain prompt responses for treatment and/or further coordinated action. Clement meticulously worked through each screen of the app on his phone, showing that his query is immediately filed and acknowledged by the FAO. He explained, “See, I already have an email saying I will get a follow-up within a few days. But if I reported something more serious or threatening – like a virus or disease – response would be very quick. Even today.”

After graciously thanking Ida and Clement for their time, I began the 70km drive back to the guesthouse, accompanied by GAPNET’s Director, Dr. Anthony Akunzule – my Ghana host and Bolgatanga trip companion. As we drove, Dr. Akunzule and I had one of many great conversations about the challenges of animal health and gender equity in Ghana. When I marveled that Ida is a wonderful combination of confidence and shyness, Dr. Akunzule explained, “She is so proud to be a CAHW. It is not usual for women to have leadership positions, or to work in this way. She is an example to other women her age who are eager to be trained as CAHWs as well. This is significant if you consider that CAHWs are not paid – they are essentially volunteers. But this training and this position gives them a sense of potential and distinction, and they learn new skills that lead to earning money through livestock and agriculture.”

In fact, the very next day, I met Margaret Aligiya, a CAHW responsible for Sirigu Community who spoke to me at length about how her husband has slowly adjusted to her presence amongst their animals, and now actually relies on her help because it has started to earn their family a small profit. Like Ida, Margaret was quiet but passionate about her work in animal health care, “I’m so thrilled to be a Community Animal Health Worker. At first the women were not involved (in animal health). But now, we are going around as voluntary workers to the villages and helping in the animal and poultry sector, and the communities are very happy with us. We women must have a chance to show what value we can bring to our families and communities.”

In Sirigu, my aim was to observe a vaccination campaign conducted by Margaret and two additional CAHWs trained by GAPNET in 2022. During the vaccination campaign, farmers would slowly arrive, with a handful of tied goats behind them. As they arrived, Margaret would record their name and number of animals, in addition to delivering injections. Although the vaccination site can appear chaotic, as farmers arrive and depart, and injections are swiftly delivered, this tedious record-taking is key to the long-term health – both animal and human – of entire regions.

On this day, 285 goats and 96 sheep were vaccinated and dewormed. Though everyone was very busy, working to beat the heat and complete the campaign before noon, I did have an inspiring conversation with Margaret about two other women trained as CAHWs in 2021. These women – Maria and Ester – are lucky enough to be receiving a small income for their health care services from farmers. Both women have used the nominal income to enrich their lives by setting up additional income-generating businesses. For example, Maria used the finances she received from her animal health work to start a small roadside shop from which she sells spices and seasonings. Ester used her CAHW income to help her set up a chair rental business.

Still, except for these rare examples, the fact is that CAHWs don’t currently receive any pay or government stipend for their services. So, until CAHWs can charge fees for their work – covering the costs of medications and transportation between farms – it is female CAHWs themselves who provide much-needed mentorship and motivation to the women around them.

Enter Anna… On another, brilliantly hot day, I found myself in Kongwania Community, at the lush homestead of and Anna Millicent Agamba. Like Ida, Anna was trained as a CAHW in 2021, but Anna was chosen for this training because she is also a local women’s group leader. Her group, called Gegitina Women’s Association – meaning “we have hope” – is comprised of 22 women all engaged in business activities such as processing shea butter, rice, and ground nuts, and selling food. As soon as I spotted her, Anna bounded toward us, hands in the air, and exclaimed, “I am so happy to meet you!” as though we were long lost friends. Anna is one of those incredible people who make you aware that generosity has nothing to do with material assets and that geographic borders do not apply to human longings for joy, purpose, and health.

As she toured me through her home compound, a sprawling garden with a substantial chicken coop and goat pen, Anna spoke passionately about her work, “At first, when we, the women, told them we would help take care of the animals, they didn’t trust us because they have the mentality that women’s duty is to be in the kitchen and take care of the children. So, how can you come and start deworming and treating an animal sore when your duty is to go and look for firewood to cook? But, as we held our (women’s group) meetings, sometimes we invited the men to sit down and we talked to them, so that they could understand us. So, with that, as time went on, they accepted us. And now, if you go to the community and mention our names, or you ask them the benefits of women animal workers, they will actually say that the mortality rates of the animals has now reduced!”

Anna proudly showed me her flourishing maize, mango, and cashew trees, describing how she had been supported by GAPNET to establish this garden crop after her CAHW training. When I asked her how her life has changed since becoming a CAHW, she readily exclaimed, “I’m always happy! The happiness I get when I come out to see my birds, my goats, and the trees growing… I’m always very happy. The animals are happy, women are learning new skills, and some are creating businesses from what they learn. There is a great change. It’s a good thing.” Anna’s words, her energy and her generosity showed me clearly that CAHWs in the Bolgatanga region of Ghana are doing more than improving the well-being of livestock and the livelihoods of farmers, they are building trust and fostering relationships within communities. They are slowly changing long-held beliefs around gender roles and women’s access to education and resources.

And just like that, I found myself on a short flight back to Tamale and a long drive toward Accra, Ghana’s capital city. There was more work to do on this trip to document and appreciate the VETS program impact and achievements, but for now, I could reflect on the incredibly inspiring women and community members I had met.

As I watched the rural landscape of Bolgatanga recede, slowly replaced by hiccups of urbanization and partially constructed complexes, it struck me that the true value of female CAHWs in Ghana exists in the collective impact of each woman’s individual story. To me, Ida, Margaret, Anna – and all female CAHWs – are gender champions in their traditional communities. These women are improving animal health and farmer livelihoods, but more significantly, they are showing other women and girls that it is possible to transform their local economies and take control of their lives. These women are contributing to reduced inequality and exclusion as communities recognize and embrace the benefits of more gender equitable households.

Of course, that is not to say it will be easy or that it will happen quickly, but it is an immeasurably valuable and necessary first step toward shifting perceptions and attitudes around gender equity in Ghana.

~~~~~~~~~~~~~~~~~~

[I wrote this article for Veterinarians Without Borders (www.vwb.org) in reflection of a trip I took to Ghana in July-August 2023 to document their “Volunteers Engaged in Gender-Sensitive Technical Solutions” (VETS) program.]