The entrenched issues of economic disadvantage and limited resources in rural Africa have created generations of vulnerable communities where the lack of safe water, sanitation, medical care, food scarcity, and educational opportunities are constant threats to survival (Appoh & Krekling, 2004; Hong, Banta, & Kamau, 2007; Nyonator, Jones, Miller, Phillips, & AwoonorWilliams, 2005; Scott, Curtis, Rabie, & Barbrah-Aidoo, 2007). Governments and philanthropic communities have responded to the presenting systems of these problems with major investment in aid, the nature of which has generally been defined by the contributors' analyses of the most effective solutions. This aid has generally taken the form of financial and/or programmatic investments. Over time, the inability to see major changes resulting from these investments has raised a serious policy question: are the historical and multi-generational effects of economic disadvantage in rural African villages so entrenched that traditional investments are ineffective?
This project asked a different set of questions: Will we get different results if we reexamine our assumptions about the most effective methods of providing aid to rural African communities? Is there a different model of sustainable change for rural African villages based on a village-guided intervention in lieu of a top-down approach from well-meaning government and philanthropic benefactors? Can we bring about sustainable change at a grassroots level through the use of principles from a community-based mental health intervention?
Based on knowledge shared by people from Ghana, West Africa and lessons we learned from a neighborhood-wide mental health intervention program in the United States, we started with the assumption that vulnerable communities, ravaged by economic disadvantage and limited resources, whether in inner city America or a rural village in Ghana, are made up of many adults who are intelligent, capable, and wish to create better lives for themselves and their families.
We also assumed that most vulnerable communities contained recognized leaders who understood and could articulate a vision of change even though they did not have access to the elements of support necessary to fund the vision. These assumptions mandated that our engagement included testing a bold hypothesis in Project OKURASE: the theory that a villageguided intervention would best define the critical elements needed to produce transformative, sustainable change and provide an effective vehicle for the participation of global partnerships in the venture.
In this article we describe Project OKURASE that is taking place in Ghana, West Africa as an example of the combination of sustainable village-guided interventions and global partnerships. Interestingly, this project grew out of a community violence prevention project that took place in a high-crime neighborhood in the southeastern United States and work that was occurring simultaneously with street children by local artists in Ghana. We begin by presenting the historical, social and cultural trauma that impacts the current context. Next, we describe Neighborhood Solutions, a community-based mental health intervention project. From this project, principles were developed that led us to successfully engage an entire community in an intervention process that produced positive outcomes for the community and its youth. These principles then were combined with the wisdom of local leaders and citizens in Ghana. The final set of principles became the basis for a sustainable way of sharing aid with a rural village in Ghana, West Africa and developing a significant global partnership characterized by equality and empowerment.
The Neighborhood Solutions Project: Historical, Social, and Cultural Trauma and the Current Context
Africa is a continent historically overflowing with natural wealth (e.g., diamonds, gold, cocoa, etc.). The historic nature of African culture was one of strong connection to the land and the view that these resources belonged to everyone and were to be shared rather than competed for (Asante, 2007). Counter to African ways of managing resources, the economic potential of this vast region led to European colonization beginning in the 15th century, first by the Portuguese and then by other European nations in their quest for control of these vast resources. The Portuguese invasions were carried out with the purpose of enriching the monarchy, promoting Christianity, and introducing plantation agriculture to meet European demands for sugar (Asante, 2007; Collins, 2010). The European invaders took land from Africans and imposed values and attitudes related to property, ownership, and culture that were fundamentally different from traditional African ones. This collision of two cultures was a shock for Africans and they did not have the power or resources to change the trajectory (Elkins, 1976). In addition, invaders brought diseases to Africa for which Africans had no natural immunity causing many deaths and increasing vulnerability of Africans (Collins, 2010).
Although slavery had been occurring in Africa for centuries (Collins, 2010), the impact of the Transatlantic slave trade beginning in 1526 fundamentally changed society within the African continent and impacted significantly greater numbers of people. After years of colonization, Africans were now viewed by Europeans as inferior and having potentially more economic than human value. Colonization set the stage and developed the widespread idea that Africans were property and less than human (Asante, 2007).
By 1650, the development of plantations on the newly colonized Caribbean islands and the American mainland led to the need for cheap labor and the brutal and inhumane capturing, kidnapping and selling of human beings as chattel and property, stripping them of all rights (Asante, 2007). Over eleven million Africans were enslaved from the coast of West Africa and sent to America (Collins, 2010).
Elmina Slave Castle in Ghana, West Africa sits on a beautiful plot of land by the Atlantic Ocean but the actions there were not so beautiful. Elmina was one of many slave castles in West Africa where Africans going about their daily life were kidnapped and held in abysmal conditions for the purpose of becoming a traded commodity to be dispersed to many countries. In the courtyard of Elmina Castle sits a church from which church members witnessed innocent people captured to be sold in trade being confined and forced to live in their own excrement, starved, killed, and physically abused. Women were raped and some impregnated by European men. The church members did not rise up against these atrocities because they followed what had been instilled across many years: "they did not view Africans as human beings" (Elmina Tour guide, 2017). Africans that survived the slave castles were taken through the dreaded "door of no return" to be put on overcrowded ships with below deck space that was normally five feet high by four feet wide (Collins, 2010), never to see their homeland, their families, their life as Africans again. They were confined in these conditions for 30 or more days. At least one-third of those who survived the untenable voyage were brought to places such as Sullivan's Island, South Carolina where they were scrubbed, sprayed down with insecticides and made ready to be sold. These very enslaved people brought forward their skills in farming, engineering of water, brick making, building, music and other areas that added to the fabric of America. They were not paid for these skills and hard work despite now being African Americans. Laws prevented citizenship or personhood and they continued to receive abusive treatment similar to what occurred in the slave castles. They continued to be viewed as less than human and not worthy of rights or humane treatment (Hurmence, 1989). For 244 years, slavery in America was a legal, permanent and inheritable condition. Laws in America supported ownership of Africans and inheritability of descendants so there was no way for Africans to get out of the situation without breaking the law or losing their lives. Even after African Americans were supposed to have freedom from enslavement, laws and norms prevented them from being viewed or treated as equal human beings and they were, in effect, stuck in a caste system (Wilkerson, 2010).
It is in this context of historical, social, and cultural trauma of disempowerment, loss of land, family, and self that for over 300 years African Americans have been working to gain equal access to human rights, civil rights, education, jobs, and personhood. Coming from nonperson status to being valued as human beings is a long arduous journey and one of the most difficult parts of the journey has been being faced with those who carried forward the century's old engrained view that people of African descent are "less than" or as people whose lives, livelihood, well-being, families, and communities are unimportant. This is a view that is passed down through generations and that is based on the race of the person rather than personal characteristics as often times people who view a certain race as unimportant or "less than" may not even know people of that race personally. Moving from being a nonperson to being valued and having to overcome obstacles that were set in the way (e.g., laws) to prevent moving up in life is a struggle that leaves many people of African descent in poverty situations and ready to give up. This ongoing struggle belies the context of the Neighborhood Solutions Project.
In 1998, the state of South Carolina commissioned several Healthy South Carolina initiatives. Within this initiative, the Division of Global and Community Health of the Medical University of South Carolina (MUSC) was asked to find a high-crime neighborhood in South Carolina and join with the people of that...