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Health Care Challenges in West Africa

A Letter from Josh Heikkila, serving as Regional Liaison for West Africa, based in Ghana

March 2019

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We give thanks to the entire Presbyterian Church (USA) community and pray that God continues to water what you have sown. Our savior Jesus Christ says: “And the King will reply to them, ‘Truly I tell you, whatever you did for one of the least of these brothers and sister of mine, you did for me.’ Matthew 25:40.”

These were the closing words of a letter I received recently from the Evangelical Presbyterian Church of Togo expressing gratitude for funds we provided them to help train a health administrator. Upon completing master’s degree studies, this new administrator will be appointed to manage the denomination’s struggling health department.

Togo is a small West African country of about 8 million people, and the E.E.P.T. (as the denomination is widely known) runs a handful of community clinics and one larger hospital. These community health clinics are known in the French language as “medical-social centers.” It’s a name I really like, because it acknowledges that health and well-being have both a medical and a social component.

As in other countries in West Africa, Togo’s health sector faces severe challenges. Many nurses and doctors trained in the region are lured away to France, England, Canada, and the U.S. because of the much higher pay they receive abroad.

In Ghana, as well, people sometimes refer to the nature of the health system in a derogatory way — “cash and carry” — because of the need to pay for services before you are treated. One Sunday afternoon several years ago, a man knocked on the door of the church, saying he was having complications from diabetes. He asked if we could bring him to the hospital. There, the nurse on duty told us point blank that if he didn’t have the money to pay for treatment, they would have to let him die. I found myself wondering, “How heartless could this nurse be?” But at the same time, you could see the exhaustion and frustration in her face.

Treating someone who didn’t have money meant the doctors and nurses would have to use money from their own pockets for equipment and services. And they were struggling, too! This man was able to sell his mobile phone to someone in the waiting room that day, and I added money of my own so he could pay for the care he needed. The man always promised to pay me back, but he never did.

Fortunately, the situation in Ghana is getting better as the economy improves and the government implements a national health insurance program that covers some basic needs. But it is still a challenging system, especially for the poor.

In Togo, “cash and carry” remains the norm. Currently, Togo has about one doctor for every 15,000 residents, while the United States and England have about one doctor for every 350. When the West welcomes doctors and nurses from West Africa to meet our own shortage of health care professionals, are we in fact contributing to the health challenges facing these countries? There are of course wonderful benefits that come from migration, but problems are also created. And we need to consider the repercussions of our actions.

Each year, countries in West Africa spend large sums of money educating doctors and nurses who then leave to work in the West. The rich countries of the West reap the benefits, while the costs are borne by poorer countries in West Africa. These Western countries could be compensating African nations for the millions of dollars they save each year recruiting African-trained health care professionals. But they are not.

With its reference to Matthew 25, the letter I received from our partner in Togo seemed especially prescient at this moment in time, as the PC(USA) responds to overtures from the past two General Assemblies that call the church to live out the gospel message of Matthew 25. There, Jesus instructs his disciples to spread God’s love, justice, and mercy in the world, especially to “the least of these.”

As we commit ourselves to live out Matthew 25, the Presbyterian Mission Agency has lifted up the eradication of systematic poverty as one central focus, “working to change laws, policies, plans and structures in our society that perpetuate economic exploitation of people who are poor.” As we work to strengthen our own health care system in the United States, and as we recruit West African professionals to fill our shortages, it’s important that we consider whether we might be actively hurting our brothers and sisters in countries like Togo, Ghana, and Nigeria. And if so, what do we do about it?

Unfortunately, there is no easy answer to these questions. But one thing is clear: in this increasingly globalized world of ours, we will only find solutions that are life-giving to all if we make a point to work together, and to listen and learn from one another.

In the fall of last year, there was a group from New York City Presbytery that came to Ghana to learn more about the culture and church here. According to the visitors from New York, Ghanaian immigrants have brought a new and fresh vitality to Presbyterian congregations in New York City. The presbytery wanted to express gratitude and learn from the country and the church that had nurtured their faith and taught them what it means to love God and be a loving neighbor.

The visit reminded me how it’s an exciting time to be part of Presbyterian World Mission. Not only is there a renewed call — in the spirit of Matthew 25 — to use the gifts that God has given us to touch the lives of others, but we are also opening up ourselves more and more to be transformed by the gifts that God has given to our global partners.

I thank you for the prayers and the financial support that have made this engagement possible. And I hope you will continue to join with us as we work together to spread God’s love, justice, and mercy in the world.


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