UPDATE: Ensuring Insurance

I have finally been able to sit down and reflect upon my experience with the health insurance campaign—being jetlagged has never served me so well. Before I begin, let me preface this post by declaring “Ensuring Insurance” a success. With everyone’s help, we were able to provide health insurance for 494 children! This means that 494 children who previously did not receive prompt, high-quality medical treatment due to financial reasons will now be able to do so.

Throughout the campaign, I encountered obstacles that were at times overwhelmingly disheartening, but ultimately proved to be a tremendous (and much needed) learning experience.

As many of you know, my initial goal was to raise $600 to provide health insurance to the 300 uninsured children in the rural village of Hodzo Ga. While, thanks to generous, compassionate supporters, I was able to more than double my initial goal (so far we have raised $1,780!), I originally believed that raising funds would be the most difficult aspect of the project. I thought that registering children would be simple; the paperwork was extremely straightforward, I had the support of prominent community members and then there was the incentive of free health insurance for a year—a promise that I thought was sure to entice people to attend the gathering.

An example of the formed used for health insurance registration

Let’s just say I was wrong. Fundraising was the easiest part. The hours I spent trying to find the best social fundraising website, writing a campaign blurb that accurately described the project without being excessively wordy (I may have failed on the wordiness aspect…), fighting with the finicky internet connection and convincing my friends, family and complete strangers that my cause was worth supporting were extraordinarily straightforward compared to the rest.

With fundraising, I was in control. My actions and my work were reflected in how many people donated, liked the facebook page and spread the word. With registering children for insurance, I was not. Going into the project, I was oblivious as to just how many other factors influenced the registration process: communication barriers, cultural divides, a lack of infrastructure, and the ever lingering question: is this even the right thing to do?

I had begun the health insurance campaign because I was overwhelmed with the helplessness that I constantly grappled with while volunteering at the hospital. Witnessing people dying and knowing that I could do absolutely nothing motivated me to find some manner, no matter how small, to change the situation. But after the first day of registering children for insurance at Hodzo Ga, I was engulfed with helplessness yet again. However, this time it was worse; I had tried my hardest to do something positive and I had not succeeded.

Looking back, what I considered to be failure—not registering 300 children in Hodzo Ga for health insurance in one day—was actually a success. 157 previously uninsured children in Hodzo Ga now have health insurance! The frustration I experienced at the small number of people who showed up, the chaos of the registration process, and the attitude of some health insurance officials towards the impoverished community members taught me a valuable lesson about public health work: everything is a lot more complicated and requires a lot more work than it may seem.

I learned from the obstacles of the registration process at Hodzo Ga how to plan a more organized registration event for the next day. As difficult as it was to accept, I realized that I needed as much help with the project as possible. This was not a situation where I could work hard independently and immediately see results. Turning to George, one of the nurses who works with Blue-Med, for help was the best thing I did.

He spoke to a friend of his, Gloria, who is a nurse in Dodome, another rural community. Gloria immediately spoke to the community and organized a gathering for the next day. Together we discussed the situation with the insurance officials and figured out a way to make the event run more smoothly. The registration at Dodome was a huge success. We were able to sign up 337 children for health insurance in one day!

Registering everyone for insurance in Hodzo Ga

The health insurance officials, Freya and Amelia (two of the other Blue Med volunteers) and me. So excited after ensuring so many kids in Dodome!

Throughout the entire process, I have learned so much, both about myself and about doing public health work in a developing country. Having now left Ghana for my final year at UC Berkeley where I am studying Public Health and Global Poverty and Practice, I am continuing to reflect on the benefits of “Ensuring Insurance”. In the short term, it is wonderful—almost 500 children will experience immediate improvements to their health care. In the long term, however, will it create a cycle of dependence? Will families not value providing health insurance for their children, thinking that a foreigner will come and register them for free? These are questions with which I constantly grapple.

I am working with George and Richard, the director of Blue Med, to expand “Ensuring Insurance” in a sustainable manner that breaks the cycle of dependence. As our discussions and ideas begin to manifest themselves, I will resume fundraising.

Getting Insured, a Project

The first patient I interacted with at the municipal hospital opened my eyes to problem of health insurance that is prevalent throughout Ghana. 

When I met her, Erica, an 8 month old who had arrived at the hospital unconscious and seizing from severe malaria, was a healthy, laughing infant who had been discharged for over a week. However, because Erica did not have health insurance, and her mother did not have the money to pay the 250 cedi hospital bill, Erica remained in the hospital for 3 weeks after she was discharged. During that time, she once again contracted malaria, a tragically common occurrence due to the large volume of both malaria patients and mosquitoes in the children’s ward.

Unfortunately, Erica’s story is a familiar one. Many children in Ghana, particularly in the rural villages, do not have health insurance. Terrified by daunting medical bills, parents are less willing to seek professional medical care for their children when they fall ill. Instead, they nurse their children with herbal remedies, which although successful at alleviating certain symptoms, have not proven to be an effective means of treatment. These children are then rushed to the nearest hospital when, as Erica did, they fall dangerously ill. Delaying professional care not only exponentially raises the cost of treatment, it also increases mortality.

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The bill from one of the hospital patients. I snapped the photo before the cost per item was written down, but you can get the idea of how expensive it would be

Lack of health insurance should not be such a devastating problem in Ghana. Unlike the US, the Ghanaian government is the sole health insurance provider. Through the National Health Insurance Scheme (NHIS), it only costs 4 cedi, the equivalent of $2 US, to insure a child for one year.

During the time I have spent at the municipal hospital, at community clinics and at rural outreaches, I have continually felt helpless to make a concrete change. I cannot do emergency surgery to save a woman bleeding to death from a ruptured ectopic pregnancy, I cannot convince the hospital staff to isolate a woman suffering from TB so that she does not infect the HIV patients with whom she shares a room.

Providing health insurance to children in need is something that I am able to do. With the help of my friends and family, I plan on providing health insurance to the 300 uninsured children in Hodzo Ga, a rural agricultural village near where I am staying in the Volta region.

This Friday, August 10, accompanied by a community nurse and an NHIS official, I will be going to Hodzo Ga to register children for health insurance. I am in the process of creating a fundraising website to provide a straightforward, transparent way for those interested to donate to the campaign. As soon as the site is done, I will post it here. In the meantime, I want to get the word out and encourage others to do the same.