Mar(k): Travel, Hiking, and "Doing Good"

musings on our life of travel and volunteering

Disability: Gabriel’s Story

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Health Insurance System failing needs of the Disabled

(story by Kiran Dattani Pitt, VSO Volunteer with Voice; co-authored by Mar Knox, VSO Volunteer with The Advocate)

The Ghanaian Health Insurance Scheme (HIS) guidelines provide that indigents are provided with free health care. However, to move down this road as a disabled person is sometimes a tortuous and rocky path indeed. Agbodzi Klomegab, or ‘Gabriel’, is one man who has gone down this path, thanks to the advocacy and assistance provided by staff at the NGO “Voice of People with Disabilities” and VSO Volunteers.

Gabriel is a homeless man with mild mental health problems, living on the street not far from the Football Stadium in Ho, in the Volta Region. He sweeps the streets around the area all day as he sees this as his job. However, not everyone appreciates his work. For many, there is a cultural belief that Gabriel’s mental health is a result of a curse and hence people yell at him, push him away or otherwise discourage him from his sweeping efforts near their store fronts. Fortunately, though, there are some compassionate people who provide Gabriel with Kenke or Agple to eat, and one woman and her daughter who live nearby also keep an eye out for him.

In early September 2009, Gabriel complained of back pain to Kiran Dattani Pitt. Rather than just provide painkillers and mask the symptoms, a more sustainable solution was sought. Accordingly, she involved Francis Asong, Director of Voice of People with Disabilities in Ghana, who attended the HIS Office in Ho and presented Gabriel’s case. He was informed that only the Head of the Scheme could make a decision about whether or not to give Gabriel a Health Insurance Card.

Weeks passed. More meetings, more waiting. Eventually, Mr. Asong was told he had to bring Gabriel with him to the HIS office, as his photograph needed to be taken. A few days later, a shower and some fresh clothes were arranged for Gabriel, to make him ready to visit the HIS office and have his photograph taken.

Finally, on 6th October, 2009 Gabriel was registered with the HIS and was given a receipt. However, he was then informed that it would be a further four months before he would get his Health Insurance Card! Although this is usual practice, it does seem that a more workable solution could be that upon production of a receipt, the approved HIS member would be provided with treatment. In most cases, people like Gabriel would wait until their health issues were at a critical stage before seeking assistance. This potential solution could ultimately save the HIS money, and focus more on prevention rather than treatment of chronic ailments.

Meanwhile, Gabriel was still complaining of back pain, so he was taken to a well known clinic in Ho. The doctor attending refused to see Gabriel and suggested taking him straight to the Regional Hospital to see a psychiatrist. How this was going to assist Gabriel’s back issue was not entirely clear to anyone involved in the case.

What ensued over the next week or so was truly astounding. The Regional Hospital insisted upon Gabriel seeing a psychiatrist and he was subsequently given strong anti-depressant drugs which he did not request. These made him dehydrated and feeling worse than when he originally went into hospital! Gabriel still had no relief for his back pain, although he was required to pay GhC 4.60 for this “assessment”.

Thanks to the efforts of the VSO Volunteers and individuals from Voice of People with Disabilities, who were genuinely concerned for Gabriel’s well being, he was eventually admitted to hospital, the anti-depressant drugs were ceased, and his back pain issue resolved. The total cost of Gabriel’s medical treatment (including psychiatric drugs that had to be thrown away) was GhC 82.80. Without somebody advocating on his behalf (and paying for medical treatment), Gabriel would still be complaining of back pain.

Gabriel’s story does bring to the fore that without external assistance, many disabled Ghanaians, some in far more dire circumstances than outlined above, would be falling through the rather wide “cracks” in the Health Insurance Scheme, which supposedly provides free health service for “indigents”.

HOW TO PROVIDE PEOPLE WITH DISABILITIES A SUPPORTIVE ENVIRONMENT

• Treat people with disabilities with respect; remember that they are people just like yourself! Treat them as you would want to be treated.

• Don’t be afraid to ask questions when you’re unsure of what to do.

• Do not assume a person with a disability is “stupid” or is any less capable of thinking than you are!

• Be patient. Take as much time as necessary.

• Remember that people with mental health issues deserve our compassion; not our pity. Be respectful of these people; remember that mental health issues can affect anyone, and it is not a curse.

• Offer assistance where possible; do this in a respectful way, and in a way that preserves the person’s dignity.

• Be a good example to others around you; if you demonstrate a respectful, supportive approach to people with disabilities, then others will follow your lead.

When it is hard not to feel victimized….

In an earlier article, we highlighted the plight of Agbodzi Klomegab (also known as Gabriel) and his difficulties in obtaining free health care through the HIS. This is just one of the many challenges that people with disabilities face; there are many more, often insidious, issues that face Gabriel and others like him every day.

Often, people with disabilities are the recipients of negative cultural perceptions. There may be a view that mental health disorders, or physical impairment results from a curse. Afflicted people are therefore shunned from society, turned out by their families and can be the victim of vicious attacks.

Gabriel has been on the receiving end of such attacks. One occurred just after his discharge from the hospital in October, when a neighbour’s daughter, Diana, noticed a woman giving Gabriel a black carrier bag. Gabriel looked into the bag and took some bread out and was about to start eating. Diana had not seen this woman before and so she asked Gabriel if he knew her. He said he did not. Diana teased him about lots of people helping him now and she wanted to know if Gabriel would share his bread, and show her what was in the black bag. The bag contained seven pieces of needles, seven pieces of meat, seven pieces of thread (used to plait hair), seven cigarettes and the bread that Gabriel was eating. Diana asked Gabriel not to eat the bread and asked him to put the bag away.

Apparently, for a person to be considered good at “juju” (black magic) they have to kill a person. The seven items listed above are part of the ritual that is followed to kill a person. The bread that was given to Gabriel would have been poisoned. Without Diana’s intervention, Gabriel may have died.

Gabriel has also been victimized by a cowardly man who steals this homeless man’s few meagre possessions. A few months ago, Gabriel had been given a new pair of slippers because his existing ones were completely in tatters. A few days later the slippers were missing and Gabriel was wearing an old pair of slippers that did not match. When he was asked what happened to his slippers, he advised that “my brother took them away”. This man, the so called “brother” has stolen other items from Gabriel, as has been witnessed by local neighbours. Once these neighbours did confront the cowardly man, and received a torrent of abuse from him. They have not intervened since, as they are now scared of what else this coward might do.

Clearly, dealing with people with disabilities is a challenge. But just because something is hard, does not mean we should do nothing. It is important for people to stand up for those who do not have a voice. We applaud people like Gabriel’s neighbours for taking an active interest in his welfare, and offer a few tips on how we can all be more sensitive to dealing with people with disabilities.

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Written by Mar(k)

January 20, 2010 at 3:43 pm

One Response

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  1. […] might also like to check out another story – Gabriel’s story, that was published for The ADVOCATE a number of months […]


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