Dr. Andrew Seidu Korkor

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3/26/2010
Dr. Andrew Seidu Korkor - National Program Manager in the Guinea worm Eradication at the Ministry the of Health in Ghana.

Guinea Worm Oral History Project - Interviewed by Nancy Hilyer

Source

The Carter Center Office of Public Information, Health Programs
453 Freedom Parkway, Atlanta, GA 30307
www.cartercenter.org

Citation

“Dr. Andrew Seidu Korkor,” The Global Health Chronicles, accessed March 30, 2017, http://globalhealthchronicles.org/items/show/4739.


Guinea Worm Oral History Project - Global Health Chronicles
Interviewed by Nancy Hilyer, March 26, 2010
Dr. Andrew Seidu Korkor - National Program Manager, Guinea Worm Eradication Program, Ghana Health Service
Nancy Hilyer (NH): This is an interview with Dr. Andrew Seidu Korkor, the National Program Manager for the Guinea Worm Eradication Program in the Ministry of the Ghana Health Service. This is about his life and his activities with the Guinea Worm Eradication Program. The interview is being conducted at The Carter Center in Atlanta, Georgia, on March 26, 2010. The interviewer is Nancy Hilyer. To begin with I want to thank you on behalf of Dr. David J. Sencer who initiated this project to document oral histories from persons who have been instrumental in eradicating Guinea worm from the world. You are one of those persons. Will you please state your full name and state for the record that you know this interview is being recorded.
Dr. Seidu (DRS): My name is Dr. Andrew Seidu Korkor, the National Program Manager for the Guinea Worm Eradication Program. I am aware that this program is being recorded for historical purposes.
NH: Thank you.
DRS: Thank you.
NH: OK, you were born in Ghana, Dr. Seidu.
DRS: Yes.
NH: Where in Ghana?
DRS: I was born in a little village called Seripe.
NH: How do you spell that?
DRS: S-e-r-i-p-e - near Bole. Bole is the nearest town - just about 8, eh, 10 miles, - about 16 kilometers from Bole.
NH: From Bole.
DRS: Yes.
NH: Can you briefly describe for me what your country was like culturally and politically when you were a child?
DRS: That was a long time ago; I don’t remember. I must have been born some time before um..
2:00
NH: You were living in the 60’s, right?
DRS: Yes, I was living in the 60’s. That was after the overthrow of the Kwame Nkrumah regime, and I really was a kid. So I didn’t know the circumstances what happened after that, and so on, and so on. I only became aware that at a certain point in time there was a military government called the National Liberation Council. And I wasn’t aware who were the bosses of and who was behind it, and so on, and so on. That’s all I can remember.
2:30
NH: So there was really no, no problem for you and your village or in Bole? Would you say there was really no problem?
DRS: No, no, there was certainly no problem; at least politically there was no problem. Of course, there were socially plenty of problems but not politically. And I think at that time, if I could look at a village today and what it was during my time I would say that my time was even better. It was much more interesting. It was more exciting as a kid. Now I see the kids in the village, and I think, wow.
3:00
DRS: I mean, there used to be a borehole in my village and we used to play with the borehole and swim in the borehole. At a certain point in time that borehole was not there. It was just about 10 to 15 years ago that it got boreholes again – along the line.
NH: Is that right?
DRS: Yes.
NH: Where did the boreholes come from in the 60’s? Who put those in?
DRS: I knew they were put up by the Government of Ghana.
NH: Of Ghana.
DRS: I remember there was a company called Ghana Water and Sewerage Company, Ghana Water and Sewerage Company.
NH: Sewerage, uh huh.
DRS: Yes.
3:30
DRS: So they were the ones in charge of that. So the borehole would break down; children would play with it. They would come out and repair it. Back in service, and then within a few weeks it’s down again, you know.
NH: Well, we know about broken down boreholes don’t we? We know about those now too.
DRS: (laughter) We do; we do.
NH: Did you – but you had a rural type of childhood?
DRS: That’s right.
NH: You were free to…
DRS: I was free to roam around, do whatever I wanted - going to a farm - that means there was farming. So you go to school; you go to farm; you go to school; you go to farm.
4:00
DRS: And then hunting, of course. You know, when I go around the villages now and as I compare against bush burning, I ask myself, wow, can bush burning ever stop in a village? Because I imagine that I was there in the village. Bush burning was – you were always looking forward to it. You burn a bush, and you go hunting. If the current generation had that kind of mentality it is not going to be easy to stop bush burning.
NH/DRS: (laughter)
4:26
NH: In talking about your life during those years as a child, it was a rural type life. You - in the village you had to go to Bole for school; I guess you did.
DRS: Yes, yes, I sat at primary school in the village, and then my senior boards were in Bole. So I used to run to Bole to school, run back to the village, run to Bole; and run back to the village. So I was running between the two communities.
NH: And so were a lot of other kids.
DRS: Yes, that’s right.
NH: You were together as age mates and…
4:58
DRS: Yes, yes. Sixteen kilometers was a very short distance; it was easy to walk it.
NH: Sure. Would your children want to walk it this day and time?
DRS: No no, I don’t think so.
NH: That’s right, that’s right - not so short any more.
DRS: The things in the village that I can remember - boreholes, apart from the boreholes we used to go to fetch water from the streams and check the sites. You carry a bucket and whatever, you talking and chatting and lots of other things.
NH: Social.
DRS: And it was part, I mean, it was said that we were taking care of the teachers -
5:30
DRS: stay in the villages. So the end of every day a group of 5 to 10 pupils were asked to go to the river and fetch water for the teacher. And we liked it, we enjoyed it. So there were a number of streams that we were fetching from.
NH: So primary school was like up until you were in, say, the 6th grade? Or like 10, DRS: Yeah, yeah, yeah.
NH: or 12 years old? Something like that - you could go to school then.
DRS: Yes, that’s right.
NH: Were you aware of Guinea worm then at all in your village?
6:00
DRS: Indeed, I had Guinea worm when I was a kid.
NH: You actually did.
DRS: Yes, I had Guinea worm as a kid. But, again, I don’t remember how severe it was because the only time I remember getting Guinea worm and what Guinea worm was like was when I was in secondary school. That one I was really conscious of the fact that I had Guinea worm disease.
NH: Ahh
DRS: I was in secondary school. And that was probably the first and last, I will say it was the last time I had Guinea worm.
NH: Was it socially embarrassing, or..?
6:30
DRS: It wasn’t socially embarrassing; it was a little bit. But I was in school at the time - first year in secondary school. And I had to stay in the dormitory for about 2 weeks without going to classes. And that is what irritated me - the fact that I was missing on classes. While my mates were in classes I was lying in the dormitory, because I couldn’t walk.
NH: You valued education.
DRS: That’s right; so that was a problem.
NH: ahh.
DRS: Yes,
7:00
DRS: That was what made me angry - that I had Guinea worm disease.
NH: What was the education situation in Ghana in those days?
DRS: I think, I think it was good. I know if I see myself at that time, compared with now - as a kid in the primary or the middle school I could write letters, I could read letters from my father, even though your father would not have to write a letter; he could call you. But in the current generation I don’t see that happening. They have very bad English, very bad manners; they don’t seem to learn.
7:30
DRS: We were very serious. Now the discipline is not there in the schools.
NH: And they have cell phones probably.
DRS: That’s right.
NH: They don’t need to write letters.
DRS: Everybody has got cell phones; they don’t write letters, and even if I wanted I could talk to my father from here, you know, so nobody writes any letters. Very interesting.
NH: It’s a different world, a different world.
DRS: It is… it has changed a lot, changed a lot.
NH: I noted that, I know you speak a lot of languages. You speak English, you speak French…
DRS: A little bit of French.
NH: A little French.
8:00
DRS: Yes.
NH: Do you speak Arabic?
DRS: No, I don’t speak Arabic. I speak my own language which is Gonja.
NH: Gonja.
DRS: I speak some languages from the Upper West – that is Wali and Dagaare, yes.
NH: Why do you speak, how did you come to speak all of these languages?
DRS: French, of course, I learned when I was in secondary school, and I liked it. I wish I could have studied further, but because I did science the combination of subjects didn’t favor me.
8:30
DRS:But for Wali and those other languages in the Upper West we stay, I mean the kind of population that we have in Bole area is a mixture of all the tribes from the Upper West and my own tribe. So we interrelate and communicate.
NH: So the English and the French were in school?
DRS: Yeah.
NH: Languages you studied formally.
DRS: Yes.
NH: And the other several…
DRS: And the others were just things that you pick up by interacting when you are talking(? c.9:00), yes.
9:00
DRS: And when, where I went to secondary school two others counted(? c.9:04) because that was Dagaare and Wali, so I had to pick it up when I was in secondary school.
NH: Well, now, your children, do they speak several languages?
DRS: They speak only English; they speak English and Ga. Because I speak a different language, my wife speaks a different language, so the common language is English.
NH: For the 2 of you… for the family?
DRS: Yes, that is what everyone speaks in the house.
9:30
DRS: Somehow, because they are very close to their mother, they also pick up their mother’s language.
NH: At least one local language.
DRS: Yeah. So they picked their mother’s language.
NH: You have been too busy working, and going to…
DRS: I have been running around, so they don’t pick my language.
NH: What about your formal education?
DRS: I went to secondary school in the northwestern corner of Ghana. It’s called Nandom Secondary School. It’s quite close to the Burkina Faso border - just about 10 miles from the Burkina Faso border.
10:00
DRS: I was there for 5 years. Secondary school was 5 years.
NH: This was medical school? No, this was secondary school.
DRS: Yeah, secondary school. Then I moved to Tamale for 6 form – or senior high school or whatever it is - for 2 years. And then moved down to Accra to the University for 7 years of medical school.
NH: Medical school in Accra. The 2 years in Tamale, were you alone or were there family there?
DRS: No, I mean it was like a boarding school. When I went to secondary school it was a boarding school.
10:30
DRS: Once I left the village school that was the end of it - no longer with my family. You stayed in the boarding school. You only came back on vacation and then stayed with your family. So it’s like after middle school that was the end of it. 5 years in Nandom, 2 years in Tamale, 7 years in Accra - that is that.
NH: Now what do you think of that system? Do you think that’s a good system?
DRS: I think it’s good.
NH: Do you?
DRS: Yes, because it enables you to go out to other places, to stay on your own, and then learn to survive on your own.
11:00
DRS: These days when children are choosing schools they want to select, their parents don’t even want them to go away from them. They want to go do national service far away. Some wanted to do service where, where we are. They don’t allow their children to go out to other places of Ghana. So they didn’t do places in Ghana- just their neighborhood, and so…
NH: Interesting. What about you and your children? Do you want them to…
DRS: O yeah,I mean, right now one of them is in Kumasi. So that is fine; she’s in boarding school in Kumasi.
NH: That’s like 5 to 6 hours’ drive.
DRS: Yes, abour 6 hours.
11:30
DRS: Yeah, that one is still in junior secondary school, So she stays with me. But when she goes to senior high she has to leave the house and live somewhere else. And most of the good schools are outside where I stay anyway. So…
NH: So it’s important if you value education. What led you… well what led you into the medical field to begin with? And then into public health?
12:00
DRS: Very interesting. I went to, to secondary school. And during secondary school I just wanted to be either a doctor or an engineer or an administrator. I was just fooling around with those things, and so I went to six form. Six form I decided I wanted to be open so that I could do whatever I wanted - either to do engineering or medicine. So I went in to do mathematics, mathematics. If I had a chance(?c.12:23) I might have gone to do computer science. But I went to do mathematics.
12:30
DRS: With that I could have gone to do computer science. Anyway, so after six form I chose, I decided to choose medicine in one university and engineering in another university. And I got taken for both. Then friends and relatives, everybody kept convincing me: why don’t you become a doctor of human beings rather than a doctor of machines. Then I went in for medicine; that was that.
NH: Are you pleased that you did? Was that a good direction to go?
DRS: It was a good decision.
13:00
NH: Was it?
DRS: Yes it was. I know that right now, I mean medicine is not, is not as rewarding in Ghana as in other places. But it was a good decision. Because you get a lot or respect; you take care of people; you get happy that you are able to care somebody, to take care of somebody. You get a lot of relief when your patient gets well.
NH: Do you do hands-on medicine?
NRS: When I was finished medical school I practiced for at least 5 years - clinical. I practiced for 1 year in Accra.
13:30
DRS: Went to Damongo to practice. Damongo is where the Mole Game Reserve is. I practiced there for 3 years. And I went to do public health. I came back to Damongo to practice before I moved on to Tamale as a public health physician.
NH: Was Tamale your first… job in public health.
DRS: No Damongo. When I was in Damongo I was combining the job of a clinician, that is, work in the hospital, at the same time the district director. So being both public health, and then clinical.
14:00
NH: Then what swayed you over to public health?
DRS: Obviously once I was in Damongo I went to do masters in public health. Of course I was fed up with the clinical. Because any time you went to consulting room people would just line up - hundreds of them. 80% of them is malaria. So it’s like you get bored with same complaints – malaria, malaria, malaria, malaria. And then you treat them, and they come back the next month. So I said, why don’t I go into something else that would prevent them from coming back?
14:30
DRS: So that dropped me into public health.
NH: Wow, interesting.
DRS: And I knew that Northern Region had so many public health problems. Indeed when I was in the university my first, my dissertation in the university was on Guinea worm. Yes my first …
NH: How did you come up with that?
DRS: Because I knew that it was very endemic in the area.
NH: Was anything being done about it at that point?
DRS: Nothing at the time – nothing. There wasn’t a program, and my dissertation was around ’86, ’86 and then ’87.
15:00
DRS: That was long before so I did surveillance of prevalence, a prevalence survey, in a village close to Bole. And same as we have today; they don’t believe water is, that Guinea worms coming from water, and so on; it’s witchcraft; its eggs; it’s so many things.
NH: Sure, sure. So that actually was your entree into Guinea worm.
DRS: Exactly, apart from the fact that I had it, and members of my family had Guinea worm before. I also studied Guinea worm as my dissertation for the undergraduate studies.
15:30
NH: I think that’s probably unique in the Guinea worm program. I bet that no one else has that path. What an interesting path. What was the Guinea worm situation in terms of numbers when you first went up to Tamale? When you first … and that was what year?
DRS: I went to Tamale in 1995.
NH: In ‘95?
DRS: Yes, the program had already started. So it was, we were just in the middle of it.
16:00
DRS: Even though the cases had come down drastically we were still heavily endemic at the time. I am not too sure the - at that time I wasn’t close with the program. I was just a public health physician. But, with the information that I have, at that point in time the Northern Region had about… or Ghana had about 8,000 cases of Guinea worm.
NH: 8,000 cases of Guinea worm.
DRS: Yes, and Northern Region was contributing about 60% of all that.
NH: Only 60 % ?
DRS: Yes, at the time. So which means as a public health physician, apart from taking care of malaria and diarrhea and other,
16:30
DRS: meningitis, I also had a responsibility for Guinea worm.
NH: When did you focus on Guinea worm?
DRS: My, as a public health physician, like I said, one of my jobs was to supervise the eradication program. Then around ‘98 I was made, in addition, in addition to being the regional public health physician I was given special responsibility for the Northern Regional program.
NH: That’s when we were there I think.
17:00
DRS: Yes, subsequently I was appointed from the national level as a Deputy National Program Manager.
NH: For the whole country.
DRS: For the whole country, but I was still based in Tamale. I was still based in Tamale as a public health physician for the Northern Region. At the same time I was assistant to the National Coordinator,
NH: For the whole country.
DRS: Dr. Bugri, to supervise, for that is where Guinea worm was. And then the year 2000 I was formally made the National Coordinator when Dr. Bugri left the program.
17:30
NH: For the whole country.
DRS: Right.
NH: Can you talk a little bit about the local people you work with in the villages, what problems you encounter with local villages?
DRS: Well, specific to Guinea worm or in general?
NH: No, I was thinking about Guinea worm… specifically Guinea worm.
DRS: Well, like I said, my first encounter with looking at what was happening with Guinea worm was when I did my studies. And they have so many beliefs as to the origin of Guinea worm.
18:00
DRS: Guinea worm is from witchcraft; they would mention so many things other than water. Even if they mention water they would tell you a witch put something into the water.
NH: May come from water but it’s still mystical, it’s still magical.
DRS: It is in their blood; it is somebody who has scared you; or somebody has traveled; someone has come to put some disease in the water. But they don’t seem to relate it to a vector borne condition. So that is number 1.
18:30
DRS: Number 2 is, I mean, on the base of this, it has been very, very difficult convincing them that drinking contaminated water is the source of Guinea worm, for that matter, that they should filter their water or boil their water, or whatever. Even if they did, even if the village - their social situations were such that it was very difficult getting 100% compliance. Incubation period of one year, you are asking somebody to filter their water for every day for one year. It’s just an impossibility.
19:00
DRS: And the cultural setting – such that people have to go out for farming; they have to go for hunting; they have to go to funerals; they have to go to weddings, they have to go to outdoorings. And in all of these situations you cannot take a filter there. Once I asked a man in Diari, oh, how come, what is the problem you had Guinea worm disease? He said, oh, he has been filtering his water thoughout the year. So I asked him, if that is so, then how come you got Guinea worm disease?
19:30
DRS: I asked him, haven’t you been going for outdoorings and weddings? He said, oh, but if you go to, if you visit your in-law and your in-law gives you glass of water (said by NH)* are you going to pull out a filter in front of him and start taking it?
NH: ahh
DRS: So the cultural situation was such that it is very difficult to get 100% compliance.
NH: And 99% isn’t quite good enough, is it?
DRS: No, and they are very busy running around looking for daily survival. So it’s very tedious for you to ask them to put their water down and then filter it.
20:00
DRS: It is too time consuming. Filtering water wastes their time, they are wasting their time. At a point in time they become frustrated. It's like they are fed up with you, your coming to tell them everyday this and that. And then again something they don't understand is why we are so passionate about the eradication effort. They ask us, what do we get out of it? We have been living with this disease for several years, and so on; and nobody ever died from it. We are coming and worrying them every day, what do we get out of it? Up until today, they believe that we are getting something out of it. That is why we are, we are concerned; they are not concerned. At a certain, in some of the villages, there are some in West Mamprusi, the chief told us, look, we are concerned. So we tried mobilize them to put stones, to step on the stones to fetch the water. The chief said "well they are not bothered, we are not bothered" - we are concerned so we should go and put the stones for them. It seems like in some communities even up until today they just don't want to bother.
NH: You should go put the stones in yourself if you want them to step down there, because you're getting a big salary and…
DRS: First of all, we are getting salary, we are getting credit, credit for it. Even now some people think, or they believe, that Carter Center has given out plenty money to ask to come and give to them and we are not giving it to them; we are spending the money and asking them to filter their dirty water to drink. So we have a lot of challenges. The whole country has managed the situation until we are focused in Dabon. You know. Dabon is around Tamale area. And the ethnic group there; I mean, it's a very proud ethnic group; they have pride in themselves.
NH: And then what's their name?
DRS: The Dagomba.
NH: The Dagomba.
DRS: Yes, they are very proud of themselves; they don't like somebody telling them what to do and what not to do. So, it's fine to be proud of yourself, but they don't.... In
22:00
DRS: this particular case it is counterproductive - So the idea of not taking something from somebody, they didn't like it. So every day we go there, “filter your water,” and they just became fed up with us. And most of it, if you listen to it, and if you understand their language, you will hear them say, oh, this one we know what to do and what we won't do. It's like to spite us. They say it. But, and that is why at a certain point in time we were advocating for a change in strategy.
NH: For what?
DRS: A change in strategy.
NH: Oh, change in strategy.
DRS: The point is that knowledge, or let's say information, I would say is universal. Everybody would tell you this and that, this and that, even though they wouldn't give you the right information. But then changing attitudes was a very big problem, first because of the social, social/cultural set up that I spoke about, and secondly because they just didn't want somebody to tell them what they were supposed to do. So we are looking for other strategies that will cut across behavior change: provision of water or the use of ABATE, extensive use of ABATE or provision of water. Now, what I notice in most of the villages is that we are not bringing anything direct to them. They are not benefitting from the program. They don't see the eradication or elimination, or removal of the worm from them, eradication or elimination, as a benefit to them. No, they don't see the health benefits, because this is something that they have been living with.
NH: It's normal.
DRS: Yes, it is normal for them. They want to see a physical benefit, so when you put water there, that is something. If you put a school there, if you put a road there, that is for their benefit from the program.
NH: So how is the water program going?
DRS: The water program project is going on well. About five years ago we started increasing our advocacy for water supply.
NH: UNICEF is involved?
DRS: Yes, and eventually we wrote a proposal and got huge, huge support from UNICEF
24:00
DRS: and the European Union basically. UNICEF added a certain component. The Ghana government endorsed it, and UNICEF is implementing it. What we have observed is that once you start the water project it's a conduit for getting people to change their attitude. Even in places that we have had a lot of difficulties in making community entry, people, communities with two chiefs, and chiefs that are quarreling; they never saw eye to eye. We managed to use the water to get into(?c.24:28) the two sides to discuss issues.
NH: Ends up influencing bigger issues, bigger issues.
DRS: Exactly, influencing bigger issues. They managed to come together. And indeed quite a number of them managed to eliminate Guinea worm before the water even started flowing. Because, OK, I'm trying to, I am going to bring you water. This what I want you to do. If you don't do it, I'll be discouraged and I'll stop. So, people kept on behaving themselves with the hope that the water will come, and the water did. Any time we started we never failed; the water came on. So they were part of the decision making, and they were also part of the implemention - formation of water sources(??c.25:12)which gave us opportunity to give out more education. Yes, the water will come. In the meantime keep on doing this. We tell you the water will help you to finish Guinea worm - not just Guinea worm; Guinea worm is a bonus, but the water will help to take care of other dread diseases. So it has been a very good project, and I think it’s doing well, it’s doing well.
NH: Can you tell me about your colleagues from The Carter Center? How many and who were the RTA assignees you worked with and some of the problems you all faced together?
DRS: When I took over as National Program Manager the first RTA was Emmanuel Puplampu. Emanuel is African American, well, I'll say he is a Ghanaian, but was domiciled in America. After that came a lady called Nwando, Nwando Diallo. After that came, I think

NH: Elvin.
DRS: Elvin came. Elvin was there at the time…Elvin was based in Tamale, and Nwando was based in Accra. After Elvin came Aryc Mosher, Aryc Mosher to Philip Downs and Philip Downs to Jim Niquette
NH: Okay.
DRS: It was very interesting working with different kinds of people- very, very intelligent. We have had a lot of our differences. Both learned to work together along the line, because we had a common cause.
NH: They were useful to the program, you feel like?
DRS: Very useful, yes, they were very useful. Because sometimes it's not easy for you as a native or as a resident there to explain to people certain issues. People have to hear it from second or third parties to believe you. Everybody wants to know I am just deceiving them, or trying to, you know, make a name for myself, give credit to myself here and there. So it’s important to have other people who will speak on your behalf, let people understand the cost implications, the health implications, or medical implications of doing this or not doing that - and then also for advocacy and mobilizing resources. All RTA's have been quite useful.
NH: So you worked well with the RTA's.
DRS: Yes, I would say I worked well with all of them, but I mentioned that we had difficulties with a few tensions here and there but for me, those difficulties did not, did not stop us from moving forward.
NH: You worked together. DRS: We worked together.
NH: Well, we are talking about tribal problems that can be a challenge to the Guinea worm program. And I recall when we were there that a chief having been beheaded caused stress in the area. Tell me about that story. Do you even recall it?
DRS: Maybe, I should even go back to 1994. In ‘94 I was filling, I was in Damongo as a District Medical Officer, and the number of cases came down to about, I think about 8,200 or so. The first serious war that really, a conflict that really delayed the whole program was 1994. And that was what he was referring to as the Guinea fowl war. There was a conflict in the eastern part of the Northern Region – started by a little skirmish or quarrel about a Guinea fowl in the market.
NH: It started as a little small thing?
DRS: Yes, and so there were several weeks of fighting; and maybe a lot of the folks were killed. That meant all infrastructure in the eastern corridor - people were fighting, vandalized all the boreholes, and in some situations they would put sand inside. In some situations they would put poison inside. So for several years the water infrastructure was down.
NH: What you're doing is poisoning or putting sand inside your enemy's boreholes, and they are doing the same to your boreholes.
DRS: That's right, that’s right. So their water infrastructure was out. But the most important thing was that because of insecurity all program activities came to a halt. It is not like surveillance can continue. I mean, who was going to go out? But if you went out then you, you cannot guarantee your life. So, for virtually a year, nothing was happening.
NH: What were the two groups? What was the name...? Was it two basic?
30:00
DRS: Basically, there were the Dagombas, and Konkumbus, and Gonjas and then Nanumbas. (NH and DRS). So that includes the four major ethnic groups, even though when it started they called it the Konkumbu/Dagomba war. But later on Gonjas and Nanumbus were also involved, because they stayed in the same area. So, of course, this conflict caused a lot of health workers to leave the area.
NH: NGO's also, I would assume...
DRS: NGO's left and the whole health system broke down. If you happened to be one of the feuding factions, obviously you were concerned about security. And after that the Northern Region has not recovered from that human resource drain.
NH: You think it hasn't recovered yet?
DRS: No, it hasn't. I remember at that time the Northern Region had up to about 3,000 health workers – nowadays about 1,800. You push anybody from Accra to that place or any place, they don’t want to come. Northern Region is known as a conflict area.
NH: And it really is not a conflict area now...
DRS: Yeah, it is... well at present there are a few skirmishes here and there,not as the papers put it, but it is still a very volatile area, especially during the dry season. People don't know that was just the first time and then, so the program has never picked up – goes up and down. There were a number of other issues that happened between '94 and 2000 - which were the health reforms. The health reform, the focus was on integration and decentralization. You don't want to integrate an eradication program; hen obviously you are looking for trouble. It becomes a control program. So people don't focus; they don’t take it as serious as they would take an eradication program. Funding - you cannot be funding direct for Guinea worm, and you need a lot of funding to focus on an eradication program. The program suffered. And then we started building up somewhere in 2000. But just when we are building up, the 2002 conflict came, and that is when they beheaded one of the chiefs.
NH: One of the chiefs...
DRS: So again we went back to square one. And up to date that kind of feuding is still there. Indeed, there isn't physical insecurity; you can go anywhere; there is no fighting, nothing. But then because it's between two families of the same tribe, Abudu and Andani, in this community, community-based activity is very, very difficult. You take a village A, the volunteer may belong to one side, Abudu; the patient belongs to one side, Andani. Can you imagine an Abudu volunteer dressing the wounds of an Andani patient? It might lead to another conflict. So for the sake of peace they try to keep off. The volunteers are aware that this person has got Guinea worm, but he is afraid to go and touch. The same way, this one is also aware that he's got Guinea worm, but she can't actually volunteer to take it off him. So between the two there's always a silent war; there's not a physical war. A lot of people don't know that this is what is happening in that area.
32:00
NH: You're talking about now, still now?
DRS: Yeah, even up to now. They compare Ghana with Sudan. In Sudan people are fighting. There's no physical assault in Ghana; people are not fighting. But that kind of individual fighting that prevents community based volunteers from doing their work effectively has placed a stop(?c.33:17) - Abudus and Andanis because of the beheading of their king some eight years ago.
NH: Eight years ago?
DRS: Yes. That still has not been resolved up to date. And so, during the latter parts or up to now we’re looking for other interventions that will sort of try to cut across this brother-brother fighting. Provide them with water, and they will stop quarreling. Oh, the pond is lying there; measure and apply ABATE. It doesn't matter which of the brothers…
NH: Who drinks it.
34:00
DRS: Yes, so those two strategies were very, very important. The use of filter cloth was fine, but, just like the malaria program, people use filters for so many things. They go to using them for filtering, for sieving cocoa, porridge, using it for curtains. I mean it's a value(?c.34:11) that they treasure. So it's not a hundred percent, but those two conflicts really, really brought the program back which should have finished a long time ago. But once you have- the first one was physical assaults; the second one was, I will say is, (NH: the silent) cultural or social assaults.
NH: Sure, just as important, just as serious.
DRS: It's very serious.
NH: Now were you ever in danger? Do you ever feel like you were in danger in the field?
DRS: Not for me personally, because, I mean, I belong to a different tribe. I don't belong to any of those. Because there's no physical fighting you don't really feel that danger. The only thing, you get frustrated, when people are not complying because his opponent is the other side, you know. And even when we go to do community social mobilization or whatever, you can hear people stand at the back and make a lot of comments here and there.
NH: Still today.
DRS: It's very difficult to mobilize communities because the chief may be of one side, but the other members of the community may be on another side. So they do not recognize the chief. The chief cannot instruct them to do this. Even if the chief says don't step into the water, they will intentionally go and step into the water, because they don't respect him. And those situations exist in a lot of places.
NH: And so some things are breaking down culturally.
DRS: Yes, a lot of things are broken down. During the past years one of the things that we passed was, the local government assemblies passed bylaws to prevent people from stepping into water. And we actually put dam guards, we got dam guards - paid some people to stay and watch the dam twelve hours a day.
NH: Oh, dam guards are individuals who do it.
DRS: So their job is to prevent people
36:00
DRS: who have Guinea worm disease from stepping into the water. We are also putting some suck-up pumps that they use to help fill their containers. If you come they will inspect your feet. If there's any Guinea worm they won't allow you to go in. And then they also help them to filter the water at the dam site. We recorded a number of incidents where people actually beat up some of the dam guards for challenging them not to step into the water. And if you trace, if you trace, they may belong to different ethnic, the Abudu/Andani, group; or it may be political. These two things are very important there.
NH: Or even one man telling another man, (DRS: Yeah) you cannot do this, is maybe part of that too, isn’t it?
DRS: Yes, especially when women are around, you know. Yes, it's like bringing out their ego. So it’s another quarrel. But when we say it was tough, somehow they say it has stabilized. But between them a lot of things, there's a lot of animosity just because the 2002 problem which has not yet been solved - because the government has said it would identify and punish the perpetrators, And they have not been able to install a new chief, and so many things are so persistent. So it's a kind of a silent quarrel.
NH: How far is that out of Tamale, how far was that chief living outside of Tamale?
DRS: About seventy, seventy miles.
NH: It was that far way?
DRS: That's Yendi, you know about Yendi?
NH: Yeah, sure.
DRS: That's Yendi. Yendi is the capital of the Dabon tribe, but a lot of Dagombas are in Tamale. But that is the most densely populated area. Incidentally Yendi is predominantly one of the ethnic, one of the sides, and Tamale is the opposite side.
NH: That's why the tension is there, isn’t it?
DRS: And if you go to everybody in Dabon, you will have a mixture of them. And to make things worse, the chief will normally beof the opposite side. So it is very difficult to mobilize them.
38:00
NH: Sure. What about the various religions in Ghana, do we have many Muslims in Ghana?
DRS: In the north they are predominately Muslim.
NH: And you've got Christians. And you've got traditional.
DRS: Traditional yes. Ghana is a very free state. And even if you go to Tamale people are mixed, it is a mixture of everybody. The villages are all mixed up.
NH: Does that pose any issues for the Guinea worm program? Religions haven’t posed any problems?
DRS: No, religion doesn’t, not seriously. On the contrary we rather use religion as channels of communication.
NH: Like clubs or-
DRS: Yes. We use the Imams when they go to pray on Friday to pass the message across. The religion doesn’t affect Guinea worm. It does affect some other health conditions like HIV/AIDS, you know. Sometimes someone will come and say, no, don't take the vaccination because they are using the vaccination to reduce your population. And definitely, yes. But if some people are die-hard religious they might apply(?c.39:06) that into other health conditions.
NH: You have fanatics there like every place else.
DRS: Exactly, that’s right.
NH: What has allowed, in your opinion, progress to be made in recent years? You have made a lot of, you talk about the conflicts there, but you've really made a lot of progress in recent years. What has allowed that progress?
DRS: You know, first of all, we had this outbreak in the Savelugu-Nanton District in 2006- 2007. And following that we started to do micro-planning. And we decided to look the best way. I've already mentioned the conflict and peoples’ cultural barriers, and so on. I discussed all these things. We said we have to look for, we have to look for something that will break down these barriers. So, number one, we made a very strong case for more supply of ABATE. I must say, ABATE supply was, it is, like giving someone a gun to go and hunt without giving him enough ammunition. The amount of ABATE we were getting was not adequate. And people had to rush Abate, or they had to leave some ponds untreated. You know the Northern Region. Today there are plenty sources of water; tomorrow they are all dried up. First rains, plenty of them. But we were not having an adequate amount of ABATE. A very strong case was made by our partners, by the Minister for Health himself, to The Carter Center; and we got an adequate amount of ABATE. I can tell you, it motivated the field staff a lot, because they told me. I don’t know whether you remember Ameria (?). One of them came and told me, look, we have saved them, because in the past they used to go to their colleagues and beg for a small allocation of ABATE just to use in the water sources, because ABATE was not enough. And any time they came we were rushing out ABATE for them. They said that was a very big motivation for them. Then the next thing we did was to identify the endemic villages and instructed our field staff - these villages are the most at risk; spend most of your time in those villages; visit them every day; visit them every week – right, visit them every week. If an active case comes up, visit that village every day; visit that village every day.
NH: Keep it contained.
41:30
DRS: Yes, if possible take the patient out of the community into a containment center. So we had about, between 11 to 15 case containment centers scattered across the region where we would physically take the person out. So that way we were able to prevent a lot of contamination. Then we engaged the services of dam guards who were also at the dam policing and inspecting peoples’ feet and making sure they were not physically entering the water. We also policed - where the dam was very big and we couldn't police or couldn’t ABATE, we placed some kind of pumps which we called suck-up pumps. It has a hose into the dam, and somebody pumps, and the water is fetched outside on the other bank.
NH: That is a slower process.
DRS: Yes, very, very slow. Very, very, tedious. We put several of them, and then we put a number of dam guards there to help them with pumping the water. At the same time we also encouraged use of filters at source. In the past they would take the water home, say they are going to filter it at home. But you can never get them to filter it at home. So they filtered it at source before they took it home. And at home they could filter again. So, ABATE application, the use of dam guards or/and suck-up pumps, the use of case containment center-
NH: You think that was good - case containment centers?
DRS: Yes. Case containment centers was good. It went well. And then, that was when we also initiated the water support – water project. The water project was started about that time. So the use of the water, our increased advocacy for improved water supply, also led people to believe that we care. Demonstrating that you care is very, very important. Some of the people will tell you,even up to date, you become friends. You are not just coming to ask them to filter dirty water and drink, but you are also bringing them good drinking water. Anytime we ask them to filter the water and drink, first they will ask you, why should I; where is the good water, the good water? You ask me to drink good water, where is the good water? You can't answer. And then you say, filter and drink. They knew they were filtering and drinking dirty water. It seems like you don't care. All you care about is that you should filter water, get rid of Guinea worm. And then you get credit, you get credit for eradicating Guinea worm, and then you leave. What do they have to show? So, typical African style, or whatever, they don’t. You lose and lose, so no compliance. But that idea of helping people to get even just one borehole, one good source of water, your whole idea changes the attitude that we care. And so the compliance began to increase, and increase, and increase, and all those things.
NH: That is huge.
DRS: Right now we have a lot of progress.
NH: What is the single greatest challenge to eradicating Guinea worm in Ghana now? And when will you see the last case? Now this is going on record, but…
DRS: You know, our biggest challenge right now is detecting cases before the worm emerges. It takes just one single undetected case - it takes one single undetected case, let’s say, in a big town like Savelugu, and they have an explosion. So what is giving us sleepless nights is that no single case should escape us. So surveillance - we should be looking every day in every corner of the country, especially the Northern Region, so that no case escapes us. And any case we detect, the case should be taken out of the community and contain him. So the single most important …
NH: That is a lot of surveillance, isn't it? It’s a lot of surveillance for one undetected…
DRS: Yes. One undetected case takes us back to square one. So what the biggest challenge is, how to maintain a very good and sensitive surveillance system for at least one year. That is the incubation period. If we are able to maintain that effort for at least one year and break the transmission, we should be OK.
NH: Do you have a date in mind, a year in mind, for your last case?
DRS: Well, we hope to see the last case this year, 2010.
NH: You think so – 2010.
DRS: We don't want to see Guinea worm in 2011. Yes, and so we are working very hard towards it. We were very motivated in the reduction during the past two years. And so far it appears the trend is continuing. So since July we haven't reported more than three cases for any particular month. July – seven cases. All the other months the highest was three cases. And so far this year we have six cases from January to March. That is as of today. That’s over 90% reduction. So it’s a continuing trend. All these six have been taken out of their communities and contained.
NH: Is that right?
DRS: And we want to make sure we continue with this trend for the rest of the year. So that is the biggest challenge. That any case which is hanging out – if we see cases this year, no problem. But we want to make sure we catch them before the worm emerges. Before they have time to contaminate any water source we take them out of the community, and then that is it. So we are hoping in 2011 we shouldn’t see any, any case.
NH: It’s very exciting.
DRS: But that is a very, very big challenge. Because looking at data from all other countries, looking at data from all countries, no country has gone from 500 to 0 in five years.
NH: Is that true? 500 cases to 0 in five years.
DRS: In five years.
NH: Well that would be very exciting if that could happen, that could be the case in Ghana.
47:42
DRS: So we are under a lot of pressure from our partners, from our government, from our communities, to make sure that Guinea worm finishes now. And so if you can imagine the situation we find ourselves.
NH: Well, I'm glad to be getting this interview this year! Because you may not be back next year! Dr. Seidu, how has public, your career in public health and your involvement with Guinea worm influenced your children, your family - has there been any influence there? Do they look at public health? Do they look at what you are doing?
DRS: At least for the subject matter, they know, because I have a lot of documents and, you know, brochures on Guinea worm that they read a lot. And they know a lot about it, the program. And they know about Guinea worm disease, how it is transmitted, how you can prevent it. Their whole problem is that the work takes me out too much. It takes me…makes me unavailable. And they complain – they complain, so that is the challenge.
NH: That's the influence.
DRS: That is the problem I have to bear with. Your daughter tells you you are traveling too much. You are going out again, and so on, and so on. So I'm hardly ever in the house for more than two weeks, or more than a week. And she went to her exams, and there is nobody around. So that’s when I sometimes,… yes, it’s quite demanding.
49:11
NH: What are any questions that you might wish that I had asked you that I didn't? Are there any questions that you wish you had been asked for this record?
DRS: Difficult, difficult to think of anything.
NH: Is it?
DRS: Yeah, difficult to think of anything.
NH: Anything else you want to talk about?
DRS: I think I will say it's been nice, it’s been nice being involved in this program. Because people asked me as late as about two weeks ago when we were with the press – they said that they hear that we don't want to get rid of Guinea worm, we don’t want to eradicate Guinea worm because we will lose our jobs.
NH: The press in Ghana?
DRS: Yeah, the press in Ghana. That is a common thing among the press, among the people, among the communities, even among the health sector. People think we don't want to eradicate Guinea worm because we will lose our jobs. I say, oh, nobody pays me, nobody pays me as a Guinea worm worker; I am paid my salary as a medical officer. So this job is not a question of me losing my job. Or, yes, it's true that maybe those who are full time Carter employees will no longer be engaged. But those of us in Ghana, I say, will simply move on to another disease. So it's a big challenge. It’s a big challenge that people interpret in a very different way. You make a lot of sacrifices to get rid of a disease that everyone will be happy about; the global; Ghana will be happy about; the communities will be happy about. And yet somehow some people have this kind of feeling that we are just perpetuating the condition because of personal interest.
NH: Well, you won't lose your job, but won't people in the villages perhaps lose their jobs, who are.?
DRS: Community based volunteers, they are volunteers; they are not paid. And as a matter of fact, the volunteers are being used for other health conditions. So with or without Guinea worm the Ghana Health Service will still be using them for other programs. We are using them for distribution of ITNs (insecticide treated nets); we are using them for Vitamin A distribution - multidrug administration, everything, so…
NH: They have had some experience.
DRS: Exactly. So volunteers will not lose their jobs. If anybody is going to lose their jobs it’s those who have been engaged directly by The Carter Center who will lose their jobs, not those of us who are being paid, we are being paid by the Service for being health workers, not for being Guinea worm, Guinea worm workers.
NH: But I would think those who even worked for The Carter Center directly would be useful in other areas of health perhaps.
52:00
DRS: Yes, they would be useful, and, indeed, we are encouraging the District Directors to continue to use them in other areas. And some of them are. You know, District Directors cannot formally employ them. Employment engagement comes from a higher level which is beyond the District Director; he can only recommend. And the person may be engaged depending on his qualifications. But locally they can (?c.52:21) be used as supervisors for NIADS (?c.52:22), for distribution of mosquito nets, among other things. So, I don’t see the problem with it. But it is part of the, it is part of the, you know…
NH: The concerns.
DRS: The concerns, yes.
NH: Sure, sure.
DRS: But it has been a very useful experience, giving me the opportunity to meet a lot of people locally and then out of the country. The good thing about all this, the interesting thing, is you meet people from outside your own profession; you know. You meet people in other sectors - Minister of Water Resources, local government, education, and whatever. So then you notice that it's not just being the health sector that matters. Taking care, getting a healthy society depends on other sectors. I am very happy that we were able to work with the Minister of Water Resources. We have been able to later on understand that it is because of their inaction that we have health problems, just using Guinea worm as an example. If there is no water, people get Guinea worm. If you don't maintain the environment, you get malaria. If you don't do this, you get this. So we try to guide people to target their energies. If you are providing boreholes, use disease prevalence to provide the boreholes, not necessarily population. It's true that the people will put all of their water resources in Accra or Kumasi, but who needs clean water? Isn't it those who are having the water related diseases? So we begin to work as a team - that we need to work together
54:00
DRS: to achieve the millennium development goals. As a matter of fact, in Guinea worm we have been able to convince people that the Guinea worm program, or the Guinea worm eradication program - it affects all the eight goals except maternal mortality. It has no direct affect on maternal mortality, but obviously it affects maternal health. Universal basic education- Guinea worm, when I was down and I didn't go to school for two weeks; I was impressed about it. Imagine a lot of kids who are down, and they cannot go to school. Food security, it has nothing to do with health directly, but Guinea worm and malaria - other things will affect the achievement of food security which is under the Minister of Agriculture.
NH: It actually spreads its fingers out very far.
DRS: Exactly. Environmental sustainability, water and then sanitation, what do you call it, empower the women, which we did with the Red Cross ladies, you know.
NH: That's right.
DRS: So the partnership that we had in this program is a very important example, still a very important example, that we need to work in partnership to achieve our health objectives, or food objectives, or education objectives. One partner cannot do it all alone, so partnership at the local level and partners with the international level. We are quite happy that The Carter Center is involved; WHO has been involved; UNICEF has been involved; JICA has been involved. And we have other people who have been involved by supporting all of these other agencies - Gates Foundation, we do know that the Gates Foundation is supporting The Carter Center, and then we do know that the DFID, the European Union- they all help other people to help Guinea worm.
NH: It’s a big family.
DRS: So it's a very big family, and, sometimes when I am making presentations I don't like to acknowledge, I don't want to mention names; because it's a very big family; and I might be mentioning only a few
56:00
DRS: and leaving out the rest. The tendency to forget something is always there, and I don't like making those mistakes. Yes, but I appreciate, I appreciate what every partner has done in the program. It's not been smooth, it’s not been smooth; we have had our differences. But we've resolved those differences, and we are moving forward.
NH: It seems like it's a nice story for the whole world to hear, don't you think?
DRS: I think so, yes.
NH: For all of us to work together like Ghana has worked together
DRS: Yeah, it's a beautiful story. The eradication program presents a very big opportunity for people to work together and bury their differences. If you don't want to bury them, don't let those differences be an obstacle to the common objective.
NH: To the big picture, right?
DRS: Yes.
NH: Dr. Seidu, thank you so much for taking this time and sharing with us today and leaving a record for future generations.
DRS: Thank you very much; you're most welcome.