Michael Forson

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2/16/2011
Michael Forson - UNICEF, New York; Water, Sanitation, and Hygiene Specialist – Headquarters Consultant to UNICEF in Guinea Worm Endemic Countries; Formerly Responsible for UNICEF Guinea Worm Eradication Support 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

“Michael Forson,” The Global Health Chronicles, accessed March 30, 2017, http://globalhealthchronicles.org/items/show/4740.

Guinea Worm Oral History Project - Global Health Chronicles

Interviewed by Nancy Hilyer, Wednesday, February 16, 2011

Michael Forson – UNICEF, New York; Water, Sanitation, and Hygiene Specialist – Headquarters Consultant to UNICEF in Guinea Worm Endemic Countries; Formerly Responsible for UNICEF Guinea Worm Eradication Support in Ghana

This is an interview with Michael Forson. This interview is about his life and his activities with the Guinea Worm Eradication Program. This interview is being conducted at the Indigo Hotel in Atlanta, GA on Wednesday, February 16, 2011. The interviewer is Nancy Hilyer. To begin with, I want to thank you on behalf of David J. Sencer, who initiated this project to document oral histories from persons who have been instrumental in eradicating Guinea worm from the world, and you are one of those persons. Michael, would you please state your full name and state for the record that you know this interview is being recorded.
MF My name is Michael Akyeamfo Forson, and I am aware that this interview is being recorded.
NH Thank you, thank you. OK, first of all, you are representing UNICEF at this international review of countries that remain with Guinea worm here at The Carter Center. Tell me about your current position with UNICEF, and what led you to this position.
MF Thank you. My current position with UNICEF is a, I am a WASH Specialist When we say WASH it’s Water, Sanitation, and Hygiene, it used to be WES, Water, Environment, and..
NH I remember that it used to be WES just a few years ago.
MF Yes, it is now WASH.
NH That is the acronym.
MF Because Water, Sanitation, and Hygiene; yeah, I am a WASH Specialist, and I just got transferred to New York to take up a new position. And within this position I have four main schedules. One of them is Guinea worm. So what I do in Guinea worm which is relevant to this interview, so I will talk about, is that I render support to countries that are still Guinea worm endemic, and then UNICEF is programming in those countries, so that together we can work and see how best we can eradicate Guinea worm from the world.
NH And will you be travelling out to these countries, or do you do that from the office in New York?
MF No, I'll be traveling to these countries.
NH You will be traveling a good bit.
MF Yes.
NH What has been, and is, the role of UNICEF in the eradication effort? I know UNICEF was a major support in the three countries that Elvin and I have been in: Uganda, Sudan, and Ghana. But what is its role in this eradication program?
MF I usually call it a partnership. In this partnership UNICEF's role actually is to look at the water supply component of the eradication program. But you see, one may just look at it as a physical engineering intervention, but then there is the behavioring change component that goes with the water supply. So what UNICEF does, is we strategically try to refocus our interventions in water supply in these countries that are Guinea worm endemic towards the provision of safe water and proper hygiene behavior changes so that it will be able to help. For example, when you talk of just filtering the water, it's an issue of behavior; it's a behavior change. So all these come in the package that UNICEF delivers. In some other countries, especially I quite remember in Ghana, UNICEF was also involved in the surveillance in the early stages, logistics support, surveillance until we reached a point where the partnership was very strong, and we limited ourselves to water supply and behavior change.
NH Who makes that decision? Do you make that decision of how you will be supporting a particular country?
MF Globally UNICEF is known as one of the heavyweights in water supply. And Guinea worm …
NH It fits into that perfectly.
MF I mean, water supply is very vital for Guinea worm. I won't call it the magic bullet, but I would say it's very essential to keep a country at zero cases. When a country breaks transmission, water supply is very essential to keep the country. If not, they will go back.
NH And not just for Guinea worm, actually for many diseases.
MF Yes, for these water borne, water related diseases.
NH You have had practical experience in water sanitation programs in countries with Guinea worm. You know, we worked with you in Ghana. Obviously clean water is key to the eradication program. Tell me about how UNICEF gets clean water. What do you do? I know there are boreholes. Is that the total picture, boreholes?
MF Not really. You see, talking about the water supply, how we go by the water supply. One is we try to look at the most cost effective way to get safe water, OK, cost effective and sustainable. For example, where you have a number of options, then you do an assessment feasibility study And then you choose the most cost effective and sustainable because the issue is, you are dealing with the rabble, with the raw (?c.5:45) people, so, when we talk of sustainability, after putting in the water supply, who maintains it? Why do you put in a complex water system where they would have to be buying treatment chemicals and all those things when you know they can't afford it at the community level? The most sustainable water source that we usually go for is the ground water.
NH Ground water.
MF That is why you see a lot of boreholes because boreholes are very cheap because you don't need to treat the water. It's already treated underground. It’s purified because it's water that moves from the surface, filters through..
NH Gets filtered naturally.
MF Yes, gets filtered naturally before it’s, I mean, stored in the, in the earth, you see, what we usually call the, I mean, is stored in the rocks, I mean, under the earth. So when you get this water, it is pure.
NH All over the world is that true?
MF All over the world. But there are one or two situations where the groundwater may have some high chemical components like fluoride. Some may be high in iron, and that may need some treatment.
NH Sulfur?
MF Yes. So based on what you get, like some cases like iron and sulfur you can aerate it, introduce a bubble through it, and it's OK. But where you have salt intrusion and those things, it becomes a bit complex. So that is one. Then the second, there are times too, some places, you just don't get a ground water. It's a very dry, arid situation. So where we have such situations like this and there is a surface water that's good, I mean good through the dry season, that has enough volume, we try to create infiltration beds that we filter the water through for the people.
NH Filtration beds.
MF We use sand filters,..
NH Sand filters.
MF Yes. We just create a bed of sand that the water comes on and filters through and comes out clean, and they are able to drink it.
NH Did you have any of those in Ghana?
MF Yes, we have done - after you left, we did a couple.
NH Did you really?
MF Chirofoyili is an example in Tolon. We have Gbungbaliga also - a couple of them we have.
NH OK, explain that a little bit to me, a sand filter...you dig a hole?
MF OK, what happens, the open pond..
NH OK, an open pond is there.
MF Yes, that the cows and the people, they all go and drink.
NH Sure.
MF So we can create a well by its side, and then by the well we have pipes, you see. We just, as the well is here, we dig a layer first before where we put perforated pipes, cover it with jute, jute sack, and then fill it with a sand which is permeable to allow infiltration. So this pipe now leads into that well. So the dirty water now filters through the sand, through the jute sack..
NH Into a well.
MF And then into the pipe and goes into the well where we put the hand pumps on the well. Then you can fetch from it, and you get the water clean. If the water is too tepid, that is, I mean, the water is too dirty and so much clay - I am trying to use the layman's language, not technical -
NH Thank you.
MF too much clay that, I mean, it clogs the filter, then what we do is we create one that requires a settling tank. So we first pump the water out into a tank where the first batch of clay settles, and then by gravity it goes to the filter bed and filters into a clear well where they fetch it.
NH What is more expensive, these beds or boreholes?
MF It all depends on the situation. These beds, at times you may look at it as expensive, but then where we have no choice and no option…
NH You would try boreholes first; they are simpler.
MF Like Chirifoyili, for example, we drilled boreholes a couple of times, all dry. Meanwhile they have this big dam that was the Guinea worm, that was creating the problem for Guinea worm. So donating is fine. Let’s make the water safe. And we pumped in some money, and it worked.
NH Really? How exciting! Really very exciting, isn’t it?
MF You need to go back and have a look at these things.
NH I do need to go back! I do need to see that. Boreholes, aren't they problematic with things breaking ...isn't that somewhat of a problematic answer?
MF It's all the issue about sustainability. You see, where this is the challenge we've had on this program because water supply, if you look at Guinea worm you say it's an eradication program. So it's like the military; move in; (?c.10:55); get it out; and you move on. But water supply is a bit different in the sense that you take the engineering approach - I'm a typical engineer - we can just go in, do the hydrological studies, fix the wells, fix the hand-pumps, and then we move on But then who owns the pump? When there is a problem with it, that means we have to come back. So just imagine as we are going, dirt in the bore-holes, the numbers move from single-digits, to tens, to twenties, to hundreds - and now you get thousands. Can you come back to all these wells again?
NH And the rest..
MF So this is where we introduce the community ownership and management. This is where the community mobilization comes in. So before we put in the well, we mobilize the community. We train them to own it. That is where the community ends up, by maybe selling the water for a token to generate some money, so that when a hand-pump breaks down, they can fix it and they don't need to wait. Because if we have to come back to thousands of wells, it will take years before we reach someone whose hand-pump has broken down. And interestingly, let me share this experience with you from Northern Ghana.
NH Yes, please.
MF You know because of these break downs of hand pumps, because we are putting in pumps, we are moving, they are breaking down. So one of our partners, the Church of Christ Water Development Program, managed to mobilize the area mechanics, the pump artisans-mechanics and then trained them to form an association where they have their constitution drawn. And now they have shared the pumps among themselves. So each mechanic is in charge of about 10 pumps in an area where he visits regularly to make sure things are OK. And the communities know which mechanic to contact if there is a problem. So this has really solved some of the problems in the northern Ghana, yes.
13:00

NH It’s a beautiful solving too, because it gives a person work.
MF Yes, it creates work for the private sector..
NH Yes, it does. Well what a smart thing. Who thought of that, Michael?
MF Well, we’ve been battling with this in the water sector for longer sustainability. It is coupled with the parts supply chains. You see there are parts in it. When making the spare parts available is one Then two is the cost of the spare parts. Then three, the personnel to manage it. And I must be honest with you, the spare parts don’t wear off quick. So it’s not a lucrative business for those who would sell the spare parts.
NH They don’t wear out quickly.
MF Yes, they don’t wear out quickly.
NH Okay, so it is not a good business …
MF If you install it well, a pump can be in operation for two to three years before you get just one part going bad. And at times that part may cost just about fifty cents. So most…
NH Not a good business.
MF So the artisans, we try to find people who are already like bicycle mechanics, and those who have something doing. So this become a top up to the business, you see. And then the other thing is the availability of the spare parts. If you just release it, the prices vary. So at the same time, the government also comes in to try to make sure the prices are regulated so that it be affordable by the village folks, you know, in order to replace them..
NH It’s not simplistic is it?
MF It is not as simple. And this one thing that I personally saw as a challenge to the Guinea worm program, because we had a lot of communities in Ghana. I mean, about five years back, five/six years back, where they had water, and the pump broke down. And because they can’t afford it, they went back to the contaminated sources, and Guinea worm re-emerged.
NH Sure.
MF So here we also have to do a lot of lobbying in the government in order to regulate the prices vis a vis the private entreprenuer and, let me say, the mechanic’s profits margin and cost of the people’s life. I mean, it’s a whole complex thing. So you see it’s not just Guinea worm. It’s bigger.
NH It’s much more; it’s much more complex. Well, that’s very interesting Michael. And I’ve been in Africa in these countries, and I never heard that complex situation. It always seemed to me that you built a borehole and that should be it. And then I never understood why you didn’t come back and fix it the next day. Now I understand. What have been, or has this been, or what do you think is the major challenge in this effort for UNICEF?
MF Okay, for UNICEF…
NH How long has UNICEF been working with you?
MF Oh! Since I joined UNICEF in 2002. And before the new UNICEF in the …
NH You joined UNICEF when?
MF 2002 - that is about nine years.
NH 2002?
MF Yeah, 2002. That is about nine years now. Yeah.. and before then in the.. I think it was in the 80s or 90s that I started operating in Ghana. What I see as a big challenge in this UNICEF, the work we do in terms of our water supply towards Guinea worm eradication. One is that work is a bit capital intensive. And interestingly the Guinea worm was also prevalent in areas where groundwater was very difficult to find. So you keep drilling, and it is all dry. And anytime you drill, money goes, because the contractor is using diesel, diesel fuel, which you are paying for it; the wear and tear of the rig; and before you drill, you need to move about three or four trucks to the sites - personnel costs all coming. So we were faced with a question of pay for dry well, or don’t pay for dry well. But the interesting thing here is that ground water exploration, how we look for ground water- underground we have fractures, cracks underground. And that is what the physical investigation where we use a method to find out where these cracks are, because those cracks serve as a pipeline that will move the water underground. The water also flows under ground just like the surface, and they float through these cracks. But interest at times when you find the crack, it might not contain water; it will be air. And you cannot tell until you dry, you drill to the crack. So when you drill there - like I said, I’m trying to be a bit, use the layman’s language a bit –
NH Good.
MF When you drill to that fracture, and there is no water in it, do you pay the contractor? Or you don’t pay? Because the investigation don’t tell you there is water or not; it only tells you there is a crack here. So this is the possible place to get the water. Then secondly you may get the water and the quality is bad. It has fluoride. Or it has salt. So what do you do? That is one challenge. And in the Northern Ghana where the Guinea worm was prevalent also, because of these drys, we have to invest a lot of money to build the capacity of our partners. So, one, we brought in Desert Research Institute…
NH Which Institute?
MF Desert Research Institute.
NH Oh, Okay! Desert Research Institute.
MF … to train our partners to explore deeper below and read meters, so that we could find if there is water beyond that. Prior to that we were drilling up to 60 meters, because the equipment we all had to investigate with we could go up to 60 meters, and beyond that is not reliable. So, one, we have to invest a lot into our partners. We have to buy new equipment. We have to buy a new drilling rig. It was so expensive. But then these things produced a lot, because when we got this equipment, we started getting..
NH Better water.
MF Better water.
NH More often.
19:47
MF Yeah. But you know, the interesting part of the whole thing of which I saw as the challenges. When you get the water running, and now the nice thing is how best the people can use the water and maintain it, and that is the behavior change part of it. How does the water transfer into economy gains? How does it transfer and give the disease reduction results that we are looking for? Because there are situations, there is water in the community but people will pass it and go to the dam, the pond, and say that they like the taste of the pond. So here…
NH It is the familiar taste; no matter how bad it is, it is familiar.
MF It is familiar. So, the behavior change component, we have to devise ways and means. It’s more of a communication strategy, pointing the people to a new something.
NH What do you do, do you do educational materials?
MF Yes…
NH Does UNICEF do that, educational?
MF Yes, we do that a lot, a lot of educational materials. But interestingly one of our partners introduced something that they said the whole rationale is: find out what they have in their village and use it. So, their workers stay right in the village with the villagers, spend some time - about two weeks - with them in the village eat their food, sleep in their houses, I mean mix up with them and gradually introduce the new water and all those things in situations where we have very difficult situations. And this partner did really very well.
NH What partner was that?
MF I think you know them. Afram Plains Development Organization. Oh, that’s after you left that we brought all these people in.
NH Oh, are you serious?
MF Yes, because we saw that we need to do something out of the ordinary, because we were doing the same thing over and over even when not achieving much results. So we have to combine these behavior change with the water supply.
NH How smart.
MF Apart from the surveillance then we ___(?c.21:54) ; in fact it resulted, that is what resulted in the development of the overall behavior change communication plan for the Guinea worm in Northern Region.
NH Your partner now, tell me the name again of the partner again.
MF Afram Plains Development Organization.
NH African Plains?
MF Afram.
NH What is Afram? It’s a…
MF Afram is a place in Ghana, it’s a river, River Afram. So the Afram Plains is a area; it’s like a suburb. So it is a development organization in that suburb.
NH Afram Plains.
MF So, yeah, for short we call them APDO.
NH OK, all right. And that was your main partner in Ghana?
MF Yeah, we had two main partners..
NH Only, in Ghana?
MF Did I say two? Yeah, I would say we have about four main partners. Church of Christ for water development program, Diare for water drilling, World Vision..
NH World Vision?
MF Yes, World Vision, also for water drilling, Afram Plains Development Organization for the behavior change and communication. Then we have the Red Cross for surveillance and also part of the hygiene promotion.
NH It’s a great partnership, isn’t it?
MF Yes, it was good, and I really enjoyed working in that partnership.
NH I should think so.
MF And it was so good. And the people were so committed. I mean, there were people who were prepared to live in the villages.
NH Are most of these people local people in these partnerships?
MF Yes, they were all Ghanaians, yes, they were all Ghanaians. And they were people who grew up in the villages,. Most of them had had Guinea worm before.
NH So they understand…
MF They knew what it is and were prepared to live in the villages and help change lives.
NH Very nice. Well now, The Carter Center is one partner.
MF The Carter Center is one partner also, yeah. I did not want to talk much about The Carter Center, because you know in Ghana when you talk of surveillance, they really carried the bigger burden on the surveillance system.
23:51
NH On surveillance.
MF Because when you look at the structure of Ghana in terms of surveillance in general, you see there was a missing gap between the village and then the district. So The Carter Center filled in where the area council is in order to get directly in contact with the village. Because the District had to work through an Area Council where it was missing.
NH And that's what they did is sort of establish a program for communication with villages, zones.
MF Yes.
NH Okay. That was their major contribution. Now you've worked with a lot of Carter Center people, I assume.
MF Yeah.
NH You worked with Elvin.
MF Yeah.
NH That was a good communication? I mean was that good with your various...
MF Yeah. Well when I joined UNICEF I think it was Elvin who was...
NH It must have been because that was 2003 was almost the time we left.
MF It was Elvin in Tamale and Nwando in Accra.
NH And Nwando, yes, right. So those were the first two Carter Center people.
MF The first two people I met with. So by that time I was also trying to find--because I was coming from a pure urban project from World Bank urban environmental sanitation project for which I was a sanitary engineer in Accra.
NH So this was brand new for you in Tamale?
MH Yes, I was coming from an urban perspective into a rural perspective. So honestly I took some time to study what was going on for me to make a good impact. OK, so I learned a lot - how the procedures are being handled, what is going on, what is the best practices going on, and then try to fill in the gap. So I would say that the first year was more for learning for me than my contribution. I think it was around that time Elvin left. So I didn't really contribute much in the first year, because it was rather all learning for me, because I was learning what was going on in order to make an impression.
NH Interesting, very interesting. I do remember Elvin's first year in Africa. I think there was a lot of learning that was going on in Uganda. You know, it was almost..
MF I quite remember during that time I used to join the case searches. Yes. And especially over the weekend we would be in the house and there would be a call that there was a Guinea worm outbreak suddenly somewhere detected in some village. And we would all rush there, try to do. So to me initially it was like, is this an ad hoc? You just get a ring, and you get up you go, or is there a plan?
NH Now was this with The Carter Center or..
MF No, it was basically with the program, the Guinea worm program.
NH With the government, the government program.
MF Yes.
NH OK, OK, all right.
MF So, like I said, I learned a lot during the first year.
NH Sure, sure.
MF And I remember when I came to Tamale first, and I came to meet Elvin. At that time my predecessor, Wally, there was one Bangladesh guy was leaving so he went to introduce me to Elvin. We talked at length about the whole Guinea worm program. Then I think within a week or so there was this review in Ho, where I went for the review; I learned a lot. So when I came back then I started to find what role UNICEF is playing in the partnership and what can be done with it. At that time there were some contractors who were - UNICEF used to contract out rather than with partners - and some contractors take the money, and they run away. I spent the first two months chasing contractors to get back to work.
NH Is that true? In Tamale?
MF In Tamale.
NH Nice experience your first year with the Guinea Worm Eradication Program! When you were in Tamale, was that strictly for Guinea worm or was that water projects and..
MF No, it was water project. Honestly I was alone at that time. I was the water officer. I was the one-man water officer in UNICEF, based in Tamale. But the focus was on Guinea Worm.
NH Was it?
MF Yeah, because at that time water was part of health. So it was a project called the Environmental Health Project. So we were basically looking at Guinea worm eradication, trachoma control. Yes. So we were looking at these two diseases.
NH A major thing. Okay, what about field experiences? Any field experiences or interesting stories you want to share for posterity? Anything you ran into in the field that you think might be interesting?
MF Yeah, we had a lot of interesting things. I remember when there was this JICA volunteer who came
28:40
and in one community, the name escapes me, in Tolon which was endemic for a long time. And we've been trying to get water; we are not getting water. So we decided to install tanks and then draw water about 30 kilometers away from Tolon. So when we were going to deliver the tanks that time my country representative Dorothy Rozga, came to Tamale. And the tanks were moving the poly tanks, and we were going there. It rained heavily, and we got stuck. I think I still have those pictures. All the Land Cruisers got stuck. By the time we managed to pull out the trucks we were all covered in mud.
NH I guess – sure.
MF It was so interesting, but at the end of the day we managed to get the tanks to the village.
NH Did you?
MF Yes, we managed to get to the village.
NH How many of you? She and you and a couple of drivers. And how many other people?
MF There were two big trucks,..
NH Their drivers.
MF Their drivers, then two Land Cruisers. Then I think there was another utility truck and the crane.
NH Oh my gosh.
MF Because the tank was very big and it needs to be lifted by the crane. So all these trucks -- the crane didn't get stuck -- but all the rest got stuck. But all the others got stuck.
NH It was a mess that day! But it was an adventure. Now that it's in the past it was a big adventure.
MF Then there was another one. Where you remember that time we did, we were doing polio immunization and we added Guinea worm case search to it?
NH Uh huh.
MF I went to the Volta Region to supervise it.
NH Volta Region.
MF Volta Region. So we went to the villages. That time, Volta Region we were seeing in Akachi District there was no cases. We went, and to my surprise, when we showed a picture in one village in Akachi they said, “Yes, it's here.” I said "What!" And there was no report. And they said "Well, the assembly man said that if we report it they always say we are not doing well, so we should never report it.”
NH Aaaaaah.
MF I was taken aback!
31:04
So we saw about three people with a worm. Even the volunteer himself had a worm. So immediately we looked for the zonal supervisor. In fact, we had to put a quick measure in place, quickly get things organized, and, in fact, we spent virtually the whole day in that community.
NH You and all the people from polio all the various ones, I guess.
MF Myself, we were a team of four doing the supervision. Myself, one, ____(?c.31:38), and I think there was someone from WHO, also someone from the government, I have forgotten the names here. So I turned the whole thing to water and Guinea worm. We allowed those doing the immunization to go, and we moved around trying to interview them to find out what water they are drinking. Interestingly, that village had very good rainwater harvesting system. So after talking, talking, then we realized, it is from the farm. So we took a walk and we identified some ponds and then reported to the Guinea worm coordinator in the region, in the district and then in the region for them to take immediate action to ABATE the pond, and all those things. In fact, it was a very shocking experience that time for me, you see, because it is human nature for... it’s just like a stigma so they wanted to hide it.
NH Sure, sure. I think that’s just a beautiful story because there you were four who had nothing to do with The Carter Center at that point - that was four people looking for polio..
MF Yeah.
NH and you come across this, but you are well aware. I mean, you are on the project, and you stop everything, drop everything, and try to organize for that village. Very interesting. Michael, do you, when did you ever - did-when did you know about Guinea Worm? What was your first awareness, I mean?
MF Oh, I knew about Guinea worm when I was a kid, because one of my cousins had it.
NH Okay, Okay.
MF But I didn’t know the nitty gritties of it until I joined UNICEF.
NH Okay, you just had a relative who had a Guinea worm., so you were familiar with it, just slightly.
MF Yeah, I was familiar with it. I knew this thing comes from water.
NH You knew it came from water?
MF Yes, I knew it came from water because that time in my village in Central Region, when it was there, I mean, there was, the congon was beaten that nobody should drink from..
NH Really?
MF the pond - yeah, that…
NH What year was that?
MF This was somewhere in the, I think it was in the early 80’s.
NH Really, okay, so already the word was out by that time.
MF Yeah they beat the congon that nobody should drink..
NH Yes, and Ghana, is this Ghana?
MF Yes.
NH You are from Ghana?
MF Yes.
NH And where are you from in Ghana?
MF I am from the Central Region.
NH Central Region, The green region?
MF Yeah (laughter).
NH It was always nice to get to the Central Region from Tamale, you know. That was very nice. Michael, Is there anything else? Any other memories or stories about this war with the Guinea worm that you would like to share? Any Questions?
MF Yes, there is something I would like to say. When I was in Nigeria, on the evaluation of that, myself and one man from The Carter Center, Domusaline(?c,34:52), we even talked of writing a story by title, the scars of Guinea worm.
NH What?
MF The scars..
NH The scars of Guinea worm.
MF Guinea worm because I fight, I saw a whole lot of people with very, I mean, terrible..
NH Devastating .
MF Devastating scars: One on the chest, some have been crippled and all those things because, see, Guinea worm affects. And in that area we went to Sokoto, a northern part of Nigeria toward the Niger border, I mean, to do the assessment there. And that place like they had understanding of doing what they call Sakia; it is like using a hot metal to punch the worm…
NH To kill it?
MF I mean when the blister comes. No, and that even cripples them. I have a picture of someone who is a cripple now.
NH Because they punched that in. It kills the worm; is that correct?
MF It doesn’t kill really, I don’t know, but I don’t think it kills the worm. But the understanding is when the blister is coming, OK, and they punch it they think it should kill the worm and they’ll be free, but it rather has other diverse effects, because I saw very terrible scars. People were just showing it to me. And it was so devastating, I mean..
NH Well, if the worm was killed, it would probably cause scarring, because the worm dying in there is very bad.
MF I-I don’t know whether the worm goes back in, but I was just moved by the scars.
NH By the scars?
MF Yeah, its…
NH So you were just thinking of doing like a pictorial of all the scars?
MF Yes, something like that. We took ___(?c.36.16) pictures of the scars of Guinea worm, but one other thing I realized during the evaluation is, you know, we’re doing a great job in terms of eradication. But from the villages I visited, and I worked in Nigeria, doing the evaluation, I can see about 20% or less who still remember issues of Guinea worm and how to prevent it.
NH 20%? Only 20% sorta remember?
MF Or less? Very few. You ask them how can you get Guinea worm, they don’t seem to remember. To me, this is something that if the government don’t really include the Guinea worm messages into their health behavior, I mean, their hygiene behavior change messages and there is a reinfection, it can be a bombshell. Because people totally forget about what to do.
NH Especially if they haven’t had Guinea worm in a few years.
MF Well, yes! Because these places I am talking about for a long time where they have not had Guinea Worm. So, in fact, most of the young people, you can ask them, they don’t know what it is.
NH Never seen it.
MF Yes, but at least their health promotion units, I think, should incorporate Guinea worm messages. Although it’s not there, but they should put it. Who knows so that in case a recalcitrant citizen comes back, the people will know what to do.
NH Can work with it quickly.
MF Yeah.
NH Well Micheal, any other questions that you wish I had asked you that I didn’t ask you that be good for the record?
MF Oh, I think one thing probably I would have liked to talk about is, you know, I think, Ghana sets a record of being the first country to drop from hundreds to zero . The cases, the Guinea worm cases.
NH Oh, to drop from hundreds to zero?
MF Yes, because we had I think 300 and something, and then this year, 8 cases. OK, one would ask what was the secret for this. And I say that what I realized is that we have a very beautiful plan in place and all those things, but we need people who will die for Guinea worm. People will give up everything and fight to do extraordinary things to get Guinea worm out. I am saying this because when this whole idea about what to do in Ghana came, a few of us got together to brainstorm and we came up with an idea. But then our bosses, (laughs) - the idea was not the ordinary idea to do because we thought of a water project that would be anchored in the Ministry of Health.
NH That would be what?
MF Would be anchored..
NH Anchored in the..
MF In the Ministry of Health. That is very strange. Usually a water project is for the Ministry of Water Resources. But here is the Ministry of Health that would run the show, and it would be implemented by the district planning and coordination unit, not the water unit at the district level. It was so strange. But then what we saw when we did that analysis, Guinea worm goes beyond a health program. It’s a development issue. So our objective was to get it on the development agenda of the district into the district planning and coordination units, okay? To foster that integration because the agric extension would be involved. The environmental health would be involved. The Health service would be involved, community development would be involved . The planning unit would be there. But once it is on their development agenda, they will also make budgets at the district level for it. You get it? And once it has also remeasured the sources with the health outcome. So assigning(?c.40:30) it to the Ministry of Health will be able to get the Ministry of Health also to take very serious note of the water project. And that's what we did in Ghana.
NH Makes such sense, and you did accomplish that?
MF We did! The eye WASH project, that’s the eye WASH project which had brought together all of the..
NH Oh, that's the eye WASH project.
MF The all mighty eye WASH project. We spent sleepless nights thinking about what to, how to design this project , the indicators, what to look out for, and all those things. It took us two years to design that project.
NH You and the others in Ghana.
MF Myself, Jim Niquette, Doctor Seidu, John Adriachi from the Community Water were the key architects who designed this project.
NH Now and that project has gone out now to,
MF It is almost completed. That is what has moved water. Communities with one place of safe (?c.41:26)water to 93 percent in Ghana . You remember when we were there, we were always in the 20 percent.
NH Sure.
MF And within a year we moved from I think from 40 something percent to sixty and the next year from sixty to ninety something.
NH Well, no wonder Guinea worm is gone from Ghana!
MF It was a very.... let me see...that project was very ambitious, but we were determined to make it.
NH You must have had some good leadership..
MF Yes.
NH in Ghana to pick up on that idea and run with it .
MFYes, that’s correct. The Ministry of Health embraced the idea. Then our country representative also supported a lot and The Carter Center at that time led by Jim Niquette was also supporting the idea.
NH Supporting, sure.
MF In fact, we, during the design of the project, we had very healthy confrontations. You see healthy head on collision. But it really promoted the work to go on. And you know, interestingly the partnership reached a point where if you go off forward, the other partners will lash at you. I quite remember when UNICEF, we were dragging our feet on the water provision. They took us on. In one meeting, they gave it to us. We sat up. Then in another meeting we realized ABATE was not going, and the question of some dams are non- Abate-able came, and we said no way. Carter Center were also not going to have it this way. Every dam must be Abated. We pushed,. They said there is no ABATE. We said we would look for ABATE wherever it is. So you see, among the partnership, we were more like monitoring each other
NH A healthy..
MF That was vey healthy.
NH I'm sure.
MF You see, and it really helped. Now we all sit and laugh about how..
NH Going out to dinner with Jim Niqutte. Oh, Michael! You know what, it has been a very, very nice interview, and nice for me, but nice for posterity. Thank you for sharing your experiences and the role of UNICEF in the Guinea Worm Eradication Program with me and with posterity.
MF Thank you.
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