Dr. Odoi-Agyarko's Mission

Dr. Odoi-Agyarko's Mission
Boston Globe - Editorial Notebook - April 1999

by Renee Loth

BOLGATANGA, Ghana-- Rural health workers know that nothing gets accomplished here without the approval of the area chiefs, so on a hot Monday afterno9n Dr. K. Editorial Odoi-Agyarko is making an important courtesy call on traditional leaders. Dr. Odoi-Agyarko has been running a clinic in this outpost 500 miles north of Ghana's capital for the past 15 years, treating conditions such as malaria, river blindness, and meningitis. But in 1994 he launched a sensitive community outreach effort in family planning and reproductive health -sensitive because, despite high maternal and infant mortality rates, people here understandably believe that each of the beautiful children strapped to their backs is a gift from God.

Dynamic, driven, and funny, Odoi-Agyarko is a kind of modern-day missionary preaching the gospel of contraception but in a way these traditional societies can accept. "You can never succeed in community work without knowing the traditions and taboos of the area," he says. So he speaks the local fra-fra dialect, organizes bicycle races and soccer matches, gets the villages help in planning income- producing projects, and pays elaborate tribute -with respect, prayers, and sometimes money - to the district chiefs.

Chief Rockson Bukari is unusual among the traditional leaders because he is young, literate, and ambitious. He is full of praise for Odoi-Agyarko. "Without health there is no society ," he says. But Bukari is also a politician -an elected member of the District Assembly -and he grows a bit testy when pressed by the doctor's guests about the pace of change, about the widespread polygamy, child marriages, and ritual female circumcision that continue even though they have been outlawed by Parliament. "I do my best," he says. " A man cannot do better than his best."

The doctor needs the chiefs because of their imprimatur and because they identify for him locally respected residents whom he will train to be community-based distributors. With a five-year grant from the United Nations Population Fund, the doctor is on his way to training 100 men and women in 40 communities across the Bolgatanga and Bongo districts. Each distributor gets a bicycle, a first-aid kit, and a chance at improving the lives and health of his or her neighbors.

Ghana, the First African nation to gain independence, in 1957, is ahead of other countries in some health indices, but a woman still stands a 1-in-20 chance of dying in childbirth -200 times the risk faced by women in the United States. In the Northern Bolgatanga district, fewer than 25 percent of births are supervised. So Odoi-Agyarko is deeply involved with traditional birth attendants, who are like midwives but lack formal education, including, often, the ability to read or write.

The Health Ministry trains the birth attendants but provides little follow-up. In Sapeliga, on -the border with Burkina Faso, the doctor makes his quarterly visit to several dozen , wizened, barefoot women who are revered for their skills. He -delivers soap -two long, yellow bars to each attendant, intended to last three months.

As we examine the record books of the births of the last quarter, the women begin to sing. One leads a kind of call-and-response, complete with -clapping hands and high-pitched warbling. The women are singing about the soap how happy they are to have it; how they will always use it before an examination. Is it any wonder the women in this dusty, poor community listen when the doctor or his workers talk about birth control or how to prevent sexual diseases?

The UN Population Fund is working hard to promote these sorts of innovative, culturally sensitive programs throughout the developing world. The United States is not the fund's biggest donor. Indeed, after slashing its contribution to $20 million, Congress has not appropriated any money this year at all; This is a shameful abdication of America's leadership role, especially in places where modest contributions can have such dramatic effects on people's lives.

In the muahut village of Gbeu there is no electricity, so when the clinic van arrives with its generator and video player to show films in a field on a spring night, the whole community turns out. After several bouts of championship wrestling, the projector shows a film about family planning, scripted by Odoi-Agyarko and performed by locals in the fra-fra dialect. Part soap opera, part slapstick, it has the audience laughing at the buffoonish husband who won't consider family planning even though he cannot feed his eight children and deeply envies his prosperous neighbor with his small family. The screen flaps in the hot breeze.

No one is being preached to here, but the missionary Odoi-Agyorko is getting his point across, anyway. And as a vermilion moon rises over field and a local chief presents him with a live guinea fowl in thanks for the services he has brought to the community, the doctor smiles. He is doing his best. And a man cannot do better than his best.