On Sunday 18 April, Brendan and Julie arrived late in Butre due to transportation setbacks between Accra and Takoradi. We set foot in Butre around 5:30 P.M. Immediately when we arrived, we met Mensiez, our good friend and respected elder in the community. We informed him of our mission to conduct surveys and he was enthusiastic to be a part of the process as a translator.
We meandered through the various paths of Butre asking men and women if they could spare some of their time to contribute to our surveys. Most agreed instantly and were even happy to help. As is typical in many villages, finding privacy to conduct the surveys was difficult. Once community members spotted two “obrunis,” or white people, sitting down with their neighbors, church members, friends or family members asking numerous questions, they became inquisitive as to what we were looking to accomplish. For the most part, the survey recipients did not mind that others heard their responses.
The first day we spent in Butre, we were unable to get so much headway on the sanitation surveys. We used the remaining time on Sunday to determine our agenda for the next day. We planned to launch the reproductive health surveys early the next morning. Julie would carry out the surveys with the female community members alongside Elizabeth, a woman she had met during her first fact-finding mission. Elizabeth acts as the Sunday School Teacher at the nearby Pentecost Church and is currently training to be a seamstress in Agona, the nearby town. Brendan, on the other hand, would first go with the Chief to the District to hopefully resolve some questions regarding the borehole we are hoping to construct. Thereafter, Brendan would return and complete some reproductive health surveys with the male members of the community with the help of Phillip, a working tour guide in Butre.
On Monday 19 April 2010, we started the day according to plan. Brendan met Chief Agyebu Tsiah IX and drove into Agona, where the local government (District Assembly) is located. We met with the Conservation Foundation, a water and sanitation NGO that works in the area, to discuss prospects of another borehole. We had been in contact with Mr. Owusu, the Managing Director of the organization for several weeks and he warmly welcomed us. As we had previously gathered, Mr. Owusu explained Butre has one working and one dysfunctional borehole. The NGO, World Vision installed both machines about ten years ago, yet one was quickly shut down after discovering high levels of arsenic that exceeded United Nations standards. Mr. Owusu explained further that there are high levels of arsenic in the Butre water. The only way to test the level of arsenic is to dig the hole for a borehole. There is a risk creating a well and having it shut down again, as well as the potential in wasting money on a borehole that will lead to water containing levels of arsenic exceeding UN standards. To hire a contractor to build the hole is estimated between 9,000 and 10,000 GhC ($7,500-$8,500), which exceeds our budget. However, if there is a contractor already working in the area, which is likely because Agona is a fairly rapidly developing area, we can ask to have borehole built at a reduced price. Another option the Conservation Foundation suggested was placing a water storage tank above the current borehole, installing an electric water pump, and setting up four to six additional taps so several people can access water at one time. This option is considerably cheaper (3,000-4,000 GhC) and would give the village adequate access to water. However, because of the system’s need for future maintenance and use of electricity, it would require a tapping fee, which is about 5-10 pesewas per day ($.03-$.07). While many communities in Ghana do charge tapping fees for better access to water, it sometimes diverts people to other free, often unsanitary sources of water in order to avoid the charges. Additionally, because women are typically in charge of fetching water, tapping fees could further economically marginalize and dispossess them. As part of our sanitation survey, which will be explained more in detail later, we found that after asking, “Would you be willing to pay a small fee (5-10 pesewas per day) for better access to water,” men leaned towards “yes,” while women leaned towards “no.” In sum, the options for BEHC and the community currently are an additional borehole, which requires no tapping fee and little maintenance, but has the risk of containing too much arsenic and may be too expensive, or a storage tank and pump, which is cheaper, efficient, and avoids the risk of arsenic, but may lead to more sanitation problems and may inhibit development of women in the society. If we were to pursue the water pump option, we would look into setting up a committee in the village to manage the funds and ensure that payments will not be weighed unfairly on the men or women. We would like the committee members to represent the various cross-sections of the community. These plans, of course, are still tentative based on what we determine is our final budget, the community’s opinion, and other factors. BEHC will hold a meeting with the people of Butre in May to decide which is the most favored alternative.
Meanwhile, Julie began conducting surveys with Elizabeth at 8 A.M. From the start, Julie informed her translator that she wanted to target women specifically, at least half between the ages of thirteen to twenty-one. A large part of our reproductive health project is based on a peer education program that is being held at the Junior Secondary School in the village, which aims at improving reproductive health education to the Butre youth. We recognize that education at a young age is essential; however, cultural sensitization and education for older constituents are necessary in order to ensure that the messages that we are communicating to the youth is in sync with the rest of the community and vice versa. To this end, the whole community, rather than just the youth, will be having the same dialogues on reproductive health, underpinning our holistic approach.
Similar to the peer review by Mensiez, Elizabeth criticized the reproductive health survey before we continued on. She informed Julie that all of the questions were appropriate to ask. Julie interviewed over twenty-five women, on Monday 19 April 2010, which took over six hours to complete. The various settings Julie was exposed to while seeking out women to complete these surveys lent her a more complete picture of the absolute poverty that has afflicted the community, particularly women: she ducked under low ceilings in somehow dilapidated mud huts while women were smoking fish, sat in dusty alleyways inquiring about the level of education of a woman that has five children and no occupation, an eighteen year old girl that is busy juggling selling oranges, selling groundnuts, and completing our reproductive health survey, a woman breastfeeding her baby while resting in a bowl near the seashore, a young lady cooing one baby and feeding the other while admitting she is single with no means of making money-these are the underlying realities of women in Butre. The economy, which is mainly comprised of fishing, does welcome women to smoke the fish and sell the fish for money; however, this economy is not able to accommodate all of the women in the community and leaves many paralyzed without a way to establish their own disposable income, relying on relatives, friends, and neighbors to support them and their children. Julie’s reproductive health surveys aimed at women in Butre illuminated a few important facts:
- The women feel that they are not favored-that is, they are not treated equally in society. The majority of women seem to define equality by economic terms. These women feel that they are at a disadvantage in the Butre community because men dominate the economy, which is fishing. They are unable to do this work because the gender division of labor in the community designates women as farmers, market women, or caregivers to children. Yet since currently the market in Butre is barely existent, it appears that there is little room for the women to grow economically, which forces them to remain dependent on the men for their livelihoods. Additionally, Mr. Joseph Yankey, a tour guide on the Butre Tourism Board, later informed us concerning the interconnected economic and gender dynamics of Butre. Say, for instance, that a woman’s husband catches a fish. The woman pays 2 Ghana Cedis for this fish to smoke and/or sell at the market. The woman could sell this for 3 Ghana Cedis and only receive 1 Ghana Cedi from the transaction. This is the market price for the fish. If she receives more money, she is able to keep it for herself; however, it is generally speaking that the wife only receives half of what the husband receives in any circumstance. This is reinforcing the control that men have in the household over the women in the household.
- In the Butre community, once a man and a woman are married, it is not a cultural norm for the married couple to use birth control. Once the woman feels she has had enough children during her marriage, if she wants to begin using contraception, she needs to seek permission from the husband. This, again, puts the woman’s health and economic wellbeing at the mercy of the man of the household.
- When asked what the survey recipient’s level of education was, many of the women laughed and said either none at all, some Primary School education, or some Junior Secondary School education. The reason is because a lack of money and many of the girls become pregnant in school.
Julie’s experience conducting reproductive health surveys was informative and helped her comprehend more fully the relationship between economics and gender in the community.
Brendan walked around and asked the males various questions on reproductive health, family planning, and alcohol. Most of the men interviewed were fisherman. They happily answered questions while sitting and sewing their torn nets after the morning catch. Only one fisherman in the surveys had received any formal education, but most of the men had received family planning in the past, mostly from church, family, or the radio. The average number of children the men had was around five, and most of them had their first child around 20 years old. Most of the men were married or married shortly after impregnating their partners, though many of them did not plan the pregnancy. Of those who did plan, they felt prepared because they had a stable job, money saved, and a home. The biggest concerns that we found were the refusal of men to use protection during sex, the high number of sexual partners in their lifetime, and the large number of children born in the family. Many of the men pride themselves on having a high number of sexual partners. Some men refused to use condoms because their churches told them not to, while most others disliked condoms because of the sensation during sexual intercourse. Many men felt that because they were married, protection was not necessary. Part of the survey also asked about alcohol use and abuse. The answers given helped us assess potential problems in the community. The results show that habitual consumption of alcohol is not too much of a concern, but violence due to alcohol is a problem. Almost all the men said that they had seen someone become violent because they were drunk and many said that they had become violent from drinking. There was a trend of men saying that “walking hard” and “acting hard” was what made them a “man.” Some believed drinking was a way to express themselves as “hard,” or “rough.” When asked why they thought people they know or they themselves drink everyday, there were two typical responses: enjoyment from the alcohol or because of a poor number of fish caught. One older man said he believed people drank too much because they had problems and one young man explained that if he did not drink during the day, he could not feel happy. Overall, the surveys were very helpful in helping us understand the issues that we will have to confront and educate on in the future.
The following day, 20 April 2010, we began at 8 A.M. finishing the remaining sanitation surveys we had left. The information gathered showed that most people washed their hands and were in general fairly sanitary. Most people said that cleanliness was very important to them and that their community was very clean. The majority of citizens believed the chief and District Assembly were responsible for keeping the community clean. All citizens said that they receive their bathing and washing water from the borehole, and nowhere else. A problem we encountered was that some people never used soap when washing their hands. Additionally, many people preferred to go to the bush or outside the home instead of the community latrine. We finished the surveys with more information on what areas to focus on, and also some more questions and inquires into other sanitation areas.
While Julie joined Brendan and Phillip, the translator, for some time, she had made previous plans to visit the nearby clinic to gather more information on its history, staff, resources, and approaches to family planning. As Julie arrived, there were approximately five or six young women waiting to be seen by the nurse. Each of these women, some looking no older than fifteen years old, had a baby with them. The clinic just opened the previous year on 26 October. Once meeting with the nurse, she was informed that the she, herself, is the only staff member of the clinic. She is paid by the government and does the following: delivers babies, makes contraception available to the community, discusses family planning, prescribes medicine (from malaria to other ailments), provides post-natal care and discusses nutrition with the community. She informed Julie that she delivers, on average, four births each month, but does not have a delivery bed. She delivers on the bed that is also used for those that are not feeling well, or sick with other medical problems. As for birth control, the nurse surprisingly offered a plethora of different options. Depo-provera, which is a shot that protects women for three months, is available for 1 Ghana Cedi. Norigynon, also a birth control shot, can be received for 1 GhC, but only protects for one month. In addition, the nurse offers male and female condoms, four for 20 Ghana Pesewas, Microgynon, also known as “the pill,” a three-month supply for 1 Ghana Cedi, and was able to inform Julie that intrauterine devices (IUDs) and Norplants, now referred to as “Jadelle,” can be accessed at Dixcove Hospital. The nurse proved that she was very educated and competent with regards to family planning and birth control and proves to be a very valuable resource to the community, particularly the women. Cecilia, the nurse, explained that she opens the clinic everyday. If she is not at the clinic, she makes her phone number available in case someone would like to see her. She resides in the village of Butre, which means she is accessible to the community.
When Julie asked if the clinic needed any materials or resources, the nurse replied that a delivery bed is necessary, as well as benches outside of the clinic for waiting patients and visitors. As BEHC sees how much selfless work the nurse is giving back to the community, we are hoping to support the clinic as much as possible, as well as work in conjunction with the clinic when holding future workshops, discussion groups, and demonstrations on reproductive health.
Yet again, we come and leave Butre almost with as many questions, if not more, than we started with. As we engage with this project more and more, we continue to uncover the innerworkings and complexities of Butre, or perhaps a trend in many rural coastal villages. We look forward to discovering more on our next visit to Butre and as we communicate with more people while in Accra.
Best,
Akosua Julie & Kofi Brendan
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