Out of Africa


A visit to a Ghanaian community for children with SEN

We were very privileged in March this year to make a return visit to Nkoranza, Ghana, to spend some time in the Hand in Hand community, a centre for abandoned children with disabilities, many of whom have autism.

A traditional Ghanaian view of disability is based on the superstition that these children are “river children” who are therefore left on river banks to drown. It’s an archaic belief that needs much challenging before more child-centred attitudes can take over people’s thinking.

Since the centre was founded more than 15 years ago by a Dutch doctor, Ineke Bosman, it has gone from strength to strength. Ineke and her American husband, Bob, put much energy into building up the community, involving local people as caregivers who live with the children and undertake all their care, receiving their board and lodging and a small allowance. Try imagining school and residential care staff doing that in England; there are no school holidays or shift patterns here.

Ineke and Bob have now retired and their role has been taken on by Albert van Galen, a retired doctor, and his wife Jeanette, a primary headteacher.

Ensuring that the children had a roof over their heads, plentiful food, clean clothing and much love and care were the centre’s initial priorities but, while these still remain vitally important today, providing education and meaningful activity are now also seen as imperative to improve the children’s life chances.

Elizabeth pretending to be locked into her own autistic world.We spent nine days there, observing activities, playing with the children and delivering four autism workshops for the caregivers. We also visited a wonderful private school that two of the children with physical disabilities attend – it was amazing to see children aged two standing at a blackboard and reciting the English alphabet – and a state run special school that several of the children with learning disabilities attend, where we were distressed to see that the children do very little. However, putting on a school uniform and going there every day adds structure, meaning and status to their lives. They are proud to go to school and it gives them some sense of independence.

When we spoke to the Head, he was also very proud of having a school for children with disabilities and talked about getting the children out into the community and changing people’s attitudes; so the positive intention is definitely there, although nobody really knows how to engage with children who cannot learn in the same way as their non-disabled peers. Staff training is minimal and there are very few resources available to the teachers and carers, so they do the best they can.

Different strokes

Autism in Africa is very different – life is slower paced, less demanding and much simpler. Daily routines are more obvious and sounds are more natural. On our previous visit we thought there were no sensory issues. This time, though, we saw that there are, but they are more subtle and cause less distress than in our frantic western, urbanised world.

Observing the children closely, and how their caregivers interact with them, gave us great insight. The children with cerebral palsy and those with learning disabilities have a better experience of life than those with autism, just like in our own society, because nobody knows how to deal with children who are hyperactive, lack attention skills, are not interested in what everyone else is interested in (football, most notably,) and hit themselves when thwarted. We nicknamed one little boy the Wild Boy of Aveyron because he was so out of control, despite the love and care he experienced every day. When we saw him alone in the pool, though, his eyes shone with joy as he felt the water all around him.

We experienced a very different perspective on the delivery of autism training. We knew that talking would not get us very far because most of the caregivers speak little English, even though it is Ghana’s official language, and we needed an interpreter to translate what we said into Twi, the local language. Instead, we took a very interactive approach, taking it in turns to pretend to be autistic and to show how to engage with individuals who are locked into their own inner world and are difficult to reach.

We had a lot of fun as they recognised in our demonstrations the characteristics of children they know and started to clap, shout and laugh at our antics. There was a clear message for them though, just as there would be for staff in the UK, about how their own behaviour impacts on the children and results in their behaviour being out of control sometimes.

There were some thoughtful questions and comments around why the children smell food before they eat it, need prompting every time before they will take a bite, and run around so much, taking no notice of anyone. We were very happy to offer answers where we could, and to share their frustrations when we couldn’t. I, and it was humbling to be part of their daily experience.

Most of the time, it was very hot, but we also experienced an amazing tropical storm, which had a dire effect on the local community – trees and telegraph poles were felled, tin roofs were sent flying off buildings and the roof of the local church fell in. We had no electricity for five days and no water without the electric pump. This meant no fans in the bedrooms, no computer access and no filling the swimming pool for the children. It was fantastic to see, though, how everyone rallied around and made the best of it, grabbing buckets of water before the power went off and sweeping up the results of devastation so quickly you almost thought you had dreamt the storm. In our country, we could learn much from these people about how to work together, and I loved their positive attitude, even in the face of adversity. As one Ghanaian said  id to me whilst surveying the storm damage, “Well, now we have more firewood and we can roast the bats that fell out of the tree, so it is all good”.

Further information

Elizabeth Attfield is Manager, Specialist Autism Training Services,Learning and Professional Development Manager at Autism West Midlands:

Sue Hatton is Autism Advisor,  at Priory Group:Team Manager, Specialist Advisors for the Quality Development Team at Craegmoor:

For more information about Hand in Hand, visit:

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