About the International Health Care Center (IHCC), a community clinic at Roman Ridge, Accra Ghana.

Since April 2003, I have been working as a full time doctor at IHCC in Accra. My name is Naa Ashiley Vanderpuye. I am 34 years of age.
I was born in the Volta region of Ghana. My father was a Ghanaian and my mother a Dutch. We had a wonderful simple life in Ghana untill my father suddenly died of perforated appendicitis. My mother, left alone with 4 daughters and not working at the time, decided to move back to Holland. All four children accompanied her.

Leaving Ghana so suddenly, at the age of 14 and under those circumstances was not easy. I had therefore promised myself that I would oneday return to my motherland. The circumstances under which my father died also motivated me. He, after being diagnosed had to be operated upon immediately, but there wasn’t a surgeon around so he would have to wait for the next day and that was just too long. He died in the early hours of that morning.

My goal was to come back to my country and help as much as I could. Medicine, before then was what I was interested in, so I went on to do just that. I was trained at the University of Nijmegen in the Netherlands.
I completed my general medical course in 1998 and went on to do tropical medicine, which I completed in 2001. I then worked for a while in the Netherlands, as a senior house officer at the department of surgery, then also in Obstetrics and Gynecology and then in Pediatrics.

I visited Ghana frequently during my school days and also during my working days and it was in 2000 that I got in touch with Mr. Eddie Donton.
Mr. Eddie Donton, a Ghanaian by birth, left for the States (California) at a very young age. He specialized in Health administration and in 1996 he went fully on his own when he started a Hospice called Care One Hospice in Riverside California. Initially, this was for all types of patients but it was at that time that the AIDS pandemic was striking hard in the USA and so his Hospice ended up receiving numerous numbers of AIDS patients in the terminal stage. His work gave him a lot of experience in the treatment and care of HIV/AIDS patients. During his frequent visits to his family in Ghana he was continuously confronted by the HIV/AIDS pandemic in Ghana. He therefore decided to open up a similar Hospice as what he was running in California. Initially his plan was to run both places. During my days in Holland, I traveled to Ghana once a year and on every trip, I tried to work in different hospitals for the time I was in Ghana. In 2000, I got in touch with Eddie and his work and I was so fascinated by this that I promised him I would, when I returned to Ghana, work with him.

In 2001 and 2002, I visited Ghana again and I worked only with IHCC. I worked there full time during my stay and it was then that we both noticed that moving up and down between the States and Ghana and the Netherlands and Ghana was not that easy. We decided therefore to give our service full time to those here in Ghana. Eddie closed down all he had in the States and moved down to Ghana. In the meantime, my friendship with Eddie kept on growing and we ended up getting married.

Since April 2003, when I came down for good, we have been running both the Clinic and the NGO. It all started with Eddies NGO, the West Africa AIDS Foundation that deals with Educational issues where HIV/AIDS is concerned. In the field of prevention we were doing tremendous work but it did not take us much too long to realize that we were also already dealing with people with the HIV disease. There was not much care and support for these people and that is when we set up the clinic.

Because of stigmatization problem in Ghana (all due to the fact that people have so little knowledge about the disease), most of these people are shunned by their communities and even so by people working in the health sector. Getting the right care is a problem for these people.
Our clinic therefore, was to give HIV/AIDS victims the chance to get the right care. We have made it a community clinic so it is open to the general public, but majorities of our patients are HIV/AIDS victims.

Since my work here as a full time doctor, I have encountered lots of challenges but my motivation is the gratitude shown by my patients. Although working here in Ghana cannot be compared to what I was doing in Holland, the little I can do for these people I am doing and the fact that they appreciate it means a lot to me and keeps me going.

Currently, I am the only full time doctor at the clinic. We have two other doctors that work here parttime but because of financial constraints and what they normally expect to be paid, we cannot afford to have them work more than a certain amounts of hours a week. The hours that we can also afford to have nurses around is also limited, in the end meaning that I do all the extra hours of the entire staff. I have had my days that I stand there and feel very frustrated and it has crossed my mind on several occasions then to just run away, but then again the poor patients are the ones that keep me going.

IHCC is now treating over 500 HIV/AIDS patients. These people are from the lowest social ladder in our society and have very little or no access to any kind of health care. Even transportation fee is a problem. Many times, patients actually ask us for some little money for them to be able to pay their transportation back home. Food is also a serious problem, financial constraints again being the main reason. Most people cannot buy common fruits and a high protein diet, what they do need is not part of their diets. At our clinic we offer the in-patients free meals.

Occasionally it does happen that we do not have certain medications and have to prescribe these for the patients so they can buy it themselves from the pharmacies in town. They mostly end up either not buying these at all or buying just a few, at least what the money they have can buy. This does not enhance treatment and rather worsens it since in such cases resistance easily builds up. Sometimes they show me prescriptions they have been carrying for months, medications that were prescribed by other doctors and what they could not buy. People walk around with the same medical problems for a long time because of this, only ending up getting worse and even in certain cases dying.

At IHCC, most of our services are free. Since we started our clinic, we have received only one big funding solely for the treatment and care of HIV/AIDS patients. This came from Barclays Bank Ghana. In the proposal we estimated to treat about 200 people with the disease with the money given, which was twenty two thousand pounds but we ended up treating well over 400. With the funding, we are able to purchase medications generally and frequently used in the treatment and care of opportunistic infections, food supplements, which is very essential, since most of the patients are malnourished and cannot afford to buy the right food. We also use part of the money in paying the staff and in buying disposable items. We frequently have to squeeze here and there but we manage to survive and carry on.

Our in-patient department is the area that faces the most challenges. Most of the patients admitted are either those with severe opportunistic infections who have kept too long with consulting a doctor or they are the terminally ill ones, shunned mostly by their communities. Most of the time, these people have had to take care of themselves and are brought in when they are almost dead. For most of them, the clinic is their last stop on their journey but at least we try to give them a dignified death. It is mostly palliative care with pain management and tender love and care what we can offer them. Visits from family members are a serious problem. Most of the time, the family does not visit and take no part in caring for these people. Many a time we have had to send corpses to the mortuary without the family knowing this. They are no where to be found. Also the families play no part in giving advice in the management of the patients, putting the whole responsibility on the clinic.
In some cases when the patients get better and have to be discharged they do not want to go. Reasons being that at the clinic, they have people to talk to, they feel comfortable and at home they are going to end up thinking too much and be shunned by the family.

Although stated on our brochure we do not do surgery at the Clinic, one because we do not have the right equipments in place and two we do not have the right staff in place. It was initially one of our plans and I think in future, being able to operate at the clinic will be very beneficial. Since my work here, I have lost three patients due to situations like this. One patient fell and had a femur fracture that needed to be operated. He eventually died. Another woman with cholecystitis eventually died and another with severe fibroids also eventually died. All three never saw an operation table. Their HIV status being the main reason. These were all young people, whose lives could have been saved.

Problems we are facing now, are the clinic lacks a lot:

Transportation: We are very much in need of an ambulance and another extra transport. The ambulance will enable us do our Home based care programs, meaning visiting the people at home. We are trying to encourage this as a means of getting communities involved in the care of their loved ones. It will also be used to transport patients from the house to the clinic if necessary and from the clinic to other hospitals for, for example, diagnostics and also if we loose a patient to enable us send the body to the mortuary. Currently, when we loose a patient, we have to charter a taxi, which most of the times is a burden. The taxi drivers charge a lot for this, if they do agree to take the corpse and also getting some of the bodies into a taxi is not an easy task and also not a nice sight.
The other transport will be used to do our rounds. At the moment we have to rely on only one car that is mostly used for the NGO and charting cars every day is not cost effective.

We also need help when it comes to our laboratory, which is not functioning at the moment. On the out-patient basis it is not a problem for I have them do their tests (if they can afford) at other laboratories. The in-patients are the problems. The are too sick to be transported and we do not even have the right vehicles to transport them and drawing the blood here and having it analyzed elsewhere, we have discovered is also not cost effective.

We also need funding to be able to get one of the other doctors to work for some more hours a day and a nurse for the night hours. We also need a ward assistant who will be able to assist the patients with the washing of their clothes and bowls and also if necessary with the feeding. Then we need to get at least one permanent cleaner for the clinic.

I am a hard working person, very devoted to my job and who does not need much in life, just a comfortable place to live and to be able to have some small time for my family (we have a 1 year old boy).
Currently, the workload is very high and it is because I bare a lot on my shoulders. I am currently a doctor, nurse, cleaner, all at the same time. I do not even have a home. At the back of the clinic, we have a small building, which is currently used partly for office purposes and partly as a temporary home. I am therefore around my patients’ 24 hours. I am doing my best, but I believe, getting more hands to assist me, will definitely improve services in the clinic and will also enable us broaden our services to our patients.
No help is too small and I thank you in advance.

This is a short description of the Clinic. We are also engaged in many other things, which I will let, you have in due course.

Dr. Naa Ashiley Vanderpuye.