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Ghana may have won the war against some of the six childhood killer diseases as early as 2014. But one of those diseases, Tuberculosis, remains a headache, not just for children but adults as well, in many parts of the country.
In the Bunkpurugu community, a small town in the North East Region, opportunities are scarce and basic services sit miles beyond easy reach. Illnesses, including Tuberculosis, become an appointment with death or, better still, a slow, exhausting trek shaped by cracked roads, long walks, and the constant tug-of-war between tradition and medical truth.
The toxic mix of the community’s poor health infrastructure and a killer cultural belief makes the fight against TB a tall order.
In this piece, the researcher takes a deeper dive into one of Ghana’s deadly bacterial infections in a community, buried in strong cultural beliefs, almost forgotten by duty bearers; a community where health officials estimate that nearly 50% of TB cases are missed or are not diagnosed due to limited access to health facilities and detection materials. The piece will also explore how lives are quietly saved from tuberculosis, how misconceptions about the disease are slowly dismantled, and what remains at stake in a region where knowledge, access, and tradition intersect.
According to the Ghana Tuberculosis Control Programme, Ghana recorded 20,599 new TB cases in 2024. While this is an improvement in detection, it is still far below the WHO’s annual target of 44,000 cases, meaning approximately 24,000 cases were missed.
So what happens to those who are diagnosed in the Bunkrugu Community in the North East Region of Ghana?
The ‘sickness’ of culture and religion
It is God’s way of drawing people back to Himself. That belief, expressed by herbalists and elders across Northern Ghana, continues to shape how many communities interpret tuberculosis, locally called “Kpaarkporu,” not as an airborne disease, but as a curse, a punishment, or the consequence of unseen moral failure. In the North East, where cases remain stubbornly high, these beliefs often send patients first to herbalists or prayer camps, delaying diagnosis, deepening stigma, and quietly widening the gap between illness and care.
For TB champions like Fati (not her real name) in the Bunkpurugu community, who was spared the spiritual blame and suspicion often attached to TB patients because of her exposure and early screening, the disease is first encountered as a lingering cough, quiet fear, and delayed decisions shaped by belief and distance, long before questions of roads, facilities, or treatment even arise.
Life on the Edge, the Bunkpurugu Community
Infographic showing the road network, towns, and district boundary of Bunkpurugu. Credit: Research Gate
Spread across 533 square kilometres (km2) and home to more than 82,000 people, Bunkpurugu sits at the edge of Ghana, brushing against Togo to the east and surrounded by Garu, Tempane, East Mamprusi, and Yunyoo-Nasuan.
It is a borderland where movement is constant, but access to health care is not.
The people here are predominantly Bimoba, and, like many northern communities, they hold deep belief systems. Most residents, 74.6%, are Christians, with 13.3% Muslims and 8.6% Traditionalists, yet spiritual explanations for sickness cut across all groups. Here, disease often wears a meaning — sometimes moral, sometimes mystical, long before it is seen as medical.
Life is hard at Bunkpurugu.
According to the Ghana Statistical Service’s Multidimensional Poverty Index (2024), of the district’s 81,074 households, more than 31,000 people — 38.3% — are multidimensionally poor. And poverty is not just a statistic; it determines the kind of sickness one is afflicted with, the kind of treatment available, how long one waits, and where one turns for help. Employment challenges, low health insurance coverage, and schooling gaps form more than 60% of the poverty burden, leaving families vulnerable long before symptoms of TB appear.
The scale of infection from Bunkpurugu to the world
While tuberculosis is deeply felt in Bunkpurugu, it is part of a much wider regional and global public health crisis.
Globally, more than 10 million people fall ill with TB every year, and over one million die, making it the leading cause of death from a single infectious agent and one of the top leading causes of death worldwide. The disease typically begins with a prolonged cough (sometimes with blood), chest pain, weakness, fatigue, weight loss, fever, and night sweats, symptoms that often go unnoticed or are misinterpreted until the illness has advanced. Ghana remains among the high-burden countries, and regions like the North East continue to carry a disproportionate share of delayed diagnoses and untreated cases.
What plays out in Bunkpurugu reflects a wider pattern: poverty, belief-driven delays, fragile diagnostics, and overstretched frontline workers intersecting in ways that allow TB to survive quietly.
Here, the distance between a cough and confirmation can stretch into weeks or months. Each delay is not just a medical risk, but a social one — giving stigma time to harden and myths space to grow.
God’s punishment or a disease?
Spiritual Herbalist/Soothsayer in Bunkpurugu. Credit: Benjamin Tenkorang
Konbonaab Binang, a Chamba, the title used for elders in Bimoba, is a well-known herbalist in the community. The route to his place is not one you struggle to trace. He is neither tucked away on the outskirts nor planted in the centre of the Bunkpurugu community.
He sits somewhere in between, a quiet axis people orbit.
The long queue waiting under the shade of his compound wall does the announcing; people come from nearby communities, from across the country, and even from outside. For decades, he has been the first stop for those seeking healing, answers, or simply a place to bring their testimonies back to.
“Those who come with TB (Kpaarkporu), they complain of chest pain, back pain, waist pain,” he told me, lowering himself into his seat as a low chant rolled off his tongue. “I consult my gods, and they give instructions on how we should treat it.”
He said it plainly: the process is spiritual, not symptom-based. People arrive with their troubles; he seeks guidance; the remedy unfolds from there. And according to him, the testimonies never stop.
From his consultations, illnesses arrive through two routes — some “natural,” and others as a warning or a message.
“Sometimes when you don’t serve God well, He brings this illness (Kpaarkporu) as punishment… to draw your attention back to Him,” he said, voice steady.
Who angered the gods?
Who broke a taboo?
Who must make amends?
He treats a wide range of conditions — “even smash poisoning,” he added — but TB (Kpaarkporu) occupies a peculiar place in his practice. For this illness, he turns to herbs, rituals, and instructions he believes the gods deliver directly.
Chamba doesn’t dismiss hospitals entirely.
He refers cases he believes go beyond his remit, cases requiring blood transfusion, cases with complications, or when his gods “say” the work must be done elsewhere. But the timing is selective. His doors do not open every day.
Some days, the gods “agree to work,” and consultations proceed. On other days, he sends people away.
“I only work on days my gods are willing to work,” he said. “So if someone comes and my gods are not willing or available, I ask them to come back another time.”
But those return visits matter.
Families can wait days, sometimes weeks, for spiritual permission to begin healing. And in the realm of TB (Kpaarkporu), those lost hours often sharpen the danger, turning an early, curable infection into a late, complicated one.
Across northern Ghana, scholars have documented these layers of belief — TB interpreted as both spiritual punishment and physical disease, with local rules about sex, alcohol, and moral behaviour folded into its causes. A 2021 study by Tabong, Akweongo, and Adongo in the Upper West Region found striking parallels: communities describing TB as curses, witchcraft, a deity’s punishment, or the consequence of taboos like coughing during sex. Many in that study spoke of people being cursed to cough involuntarily as punishment for wrongdoing — a spiritual sting that becomes kɔronkpong (how TB is described locally in Dagaare). Others noted that excessive drinking or sleeping with someone’s partner could attract the illness as retribution.
The study also documented a split that mirrors what Chamba, the herbalist, described: two types of TB, one spiritual, requiring ritual care, and one “contagious,” believed to spread through utensils, sputum, or even flies.
And in places like Bunkpurugu, Chamba stands right at that crossroads — where belief and biology collide, and often decide the path a patient takes.
Walking long miles, wrong diagnosis: John’s struggle with TB
A photo of the entry to the Tatara community. Credit: Benjamin Tenkorang
John (not his real name), 52, lives in Tatara, a border town where proximity to Togo sometimes dictates the path to care. His first symptoms were fever and a persistent cough. The nearest hospital in his community is over 100 kilometres away, and cross-border care is often the first option. “We are in a border town, and Togo is closer than the nearest hospital, so I sought medical help there. But on the first visit, they misdiagnosed me. They didn’t determine it was TB. I was treated for fever,” John narrated.
After returning to the same clinic in Togo, John was finally diagnosed with tuberculosis and began treatment. “I thought it was death because of the nature of the illness. I had no idea it was TB,” he recalls. The illness came and went, and the community initially encouraged him to try herbs. “I tried some herbs given by the people, but it wasn’t working for me. I decided to go to the hospital.”
John emphasises how challenging access to care has been. Walking the long distances to hospitals often meant missing doses. “Seeking health care from Nano was difficult, about 80 to 100 kilometres. Even the nearest hospital here is over 100 kilometres away. I don’t have a motorbike, so I walk. Sometimes I beg for a ride, but it’s not always available.”
Farming is John’s only source of income. The dry season, irrigation problems, and poor road conditions make both work and access to treatment difficult. “If there were some movable vans with machines and drugs stationed in our community or clinics a bit closer, the struggle to seek health care would be much easier,” he says.
His wife adds context to his experience. “Before we went to Nano, it was just painkillers and herbs. One community member suggested Nano for proper medical help. The illness goes and comes. Some community members suggested it was an ulcer. Sometimes at the hospital, drips are put on him. Even after a year’s treatment, he is sometimes fine, sometimes ill.
After medication, he resumes alcohol, and the illness comes back.” She sighs, reflecting the compounded challenges of poverty, habit, and disease.
Picture of an alcoholic product on John’s compound. Credit: Benjamin Tenkorang
Battling TB on the frontline
A picture of the community health centre. Credit Benjamin Tenkorang
When the search for spiritual answers hits a snag and the last herbal remedy fails to bring relief, the sick eventually turn to the Bunkpurugu Health Centre. Many arrive late, breath short, bones thin, hope half-spent.
This is where Nurse Practitioner Konlan Simon meets them, often for the first time in their long journey across healers, rituals, and whispered advice.
“There is only one Gene-Xpert in this whole district,” he told me, his tone carrying the fatigue of routine frustration. “And it’s not even here, it’s in Binde.”
Binde is the ‘nearest’ referral point.
Binde is a long, rough ride away. On days when the road turns to mud or the sun becomes unbearable, the journey drags longer than it should.
But the bigger problem sits inside the lab: electrical power.
“We experience outages a lot. It is normal here. Sometimes electricity goes off in the middle of running samples, and we have to wait. People come from very far communities, but the machine doesn’t care that they walked eight or ten kilometres to get here.” Simon said.
“Imagine travelling with a sample from here to Binde, only for light out to mess it up halfway,” he said, shaking his head. “It is frustrating. Patients suffer as a result.”
Most patients arrive at the health centre only after trying every other option.
“The natives usually exhaust herbs, spiritualists, pastors… all that,” he said. “Some don’t even know it’s TB. Some know and still delay. Some patients tell you openly that they first went to a shrine or a herbal place because they believed someone cursed them,” he said. “We have to spend the first few minutes convincing them that TB is not spiritual — it’s bacteria. But they only believe us after the test.”
For Simon and his team of practitioners, entering them in the presumptive register, collecting sputum labelled cups, rushing samples to Binde before the sun drops, waiting for results, and then, if the test is positive, walking house to house to trace every person the patient may have exposed is their part support to this fight, as they also undertake community engagements, radio talks, speak in churches, health walks, active case searches and screenings, focus group discussions, and among others.
Bunkpurugu’s position along the border adds another layer to the work.
Some patients walk in from Togo.
“And we can’t turn them away,” he said. “It’s about health. You help whoever comes.”
Sometimes, the team dips into their own pockets to fuel the motorbike to Binde, buy phone credits to follow up on results, or even pay for medicines when the centre runs out.
He said quietly. “Their lives matter.”
“Anticipating a district hospital”
The strain stretches into decisions made by community leaders who must defend a system they know is sputtering under the weight of need.
Mr Jeremiah Labik, the Assemblyman for Bunkpurugu Central, presides over eight communities. His daily work gives him a front-row view of how thin the health infrastructure has been stretched.
“We were anticipating a district hospital,” he said, leaning back as though the weight of the abandoned foundation still sat on his shoulders. “We hoped Agenda 111 would bring it. The project was raised… and then left.”
The concrete blocks in the middle of the community still stand — an unfinished promise. The approximately $17 million, 60-bed capacity project was expected to be completed and ready for use by June 2024.
The Agenda 111 project in Bunkpurugu. Credit: Benjamin Tenkorang
In community meetings, Mr Labik said he repeatedly pushes the district planning team to keep the hospital on the development agenda. He argues that even if politics has complicated the name “Agenda 111,” the facility itself shouldn’t be sacrificed.
“Call it a District Hospital. Call it anything,” he said. “We just need it completed.”
Most residents move between facilities in Bunkpurugu, Binde, and BMC — each with its own limitations. But the Assemblyman raised an issue that the health workers cannot fix: language.
The Baptist Medical Centre (BMC) in Nalerigu is the region’s largest referral point and a TB village.
“At BMC, they are Mamprusis. They don’t speak our language,” he said. “Sometimes our people go there and are left unattended. A sick person cannot advocate for himself in a language he doesn’t speak.”
And for those admitted far from home, the difficulties multiply:
“How long can you survive there and feed yourself when no one understands you?” he asked.
A matter of neglect or priority?
As the assemblyman dreams of a future district hospital, the District Chief Executive, Joseph Ali Lachir, speaks in a language familiar across Ghana’s neglected frontiers, one of pressure, trade-offs, and persistent limitations.
With more than 100 communities under his jurisdiction, Lachir describes the district’s widening health gaps not as abandonment but as a casualty of competing demands.
“We are trying to put up CHPS compounds across the district,” he said, noting that many are still shells waiting for equipment. “They are not fully furnished, but identifying the problem alone is some progress.”
On tuberculosis, he refuses to concede that the disease is widespread.
“I don’t think it is so rampant here,” he said. “The health practitioners say otherwise because they have the data.”
But even where he acknowledges the weight of their evidence, he falls back on the reality that defines nearly every decision in Bunkpurugu: prioritisation.
“Everything is important, especially when it has to do with lives,” he said. “But they are prioritised. It’s a matter of priority.”
“For instance, in this community, drug abuse by the youths is a serious issue,” he explained. “Also, because it is a border town. We would have been happy to have the machines to help eradicate this illness, but our resources are limited.”
Then he pointed to the quiet giant that shapes governance and budget allocation here — the internal conflicts that smoulder and erupt without warning. Land feuds, chieftaincy disputes, clashes that displace families overnight — each one eating into the district’s already thin budget.
“Solving those internal conflicts is expensive,” he said. “We have to find homes for displaced people, maintain security, ensure peace… all of that.”
By the time the district finishes paying for peace, only scraps remain for health and other projects.
The survivor who returned as a lifeline
In 2019, Fati (not her real name) was like many others in Bunkpurugu — unaware that a persistent cough, weight loss, and fever were signs of a disease that could silently claim her life. “It started with a catarrh, then I started coughing severely, and a family member advised me to go to the hospital. I was screened for TB, and the results came back positive,” she recalls. Unlike others in her community, Fati did not first seek spiritual remedies or herbal interventions. Her early exposure to medical information, combined with prompt screening, spared her from the stigma and misconceptions that often shadow TB patients in the North East.
Treatment was gruelling, but with support from her family and local health workers, she completed the regimen and was cured. The experience left her with more than just physical recovery; it instilled in her a mission.
Today, Fati volunteers with TB Voice Network Ghana, a community of survivors who use their lived experience to educate and support others. Founded in 2007 with backing from the Chest Clinic at Korle Bu Teaching Hospital, and later strengthened in 2013 through capacity-building by the West Africa AIDS Foundation, the network trains survivors to become advocates, counsellors, and champions within their communities.
Through TB Voice Network, Fati and her male colleague volunteer across the district’s difficult terrain, holding community durbars, visiting households, and teaching in schools and churches. Their goal is to dismantle myths that give TB room to thrive.
“TB can be treated and cured,” she tells crowds. “We should not hide from it but rush to the nearest health facility when the symptoms appear.”
But the work is not just about explaining symptoms. It is about navigating a health system stretched thin across vast distances.
In the North East Region, home to hundreds of thousands, there is only one movable X-ray machine serving everyone. Samples from Walewale, Yagaba, and Chereponi must be sent to BMC for processing. Those from Yunyoo, Nakpanduri, Bunkpurugu, and other surrounding communities are sent to Binde.
For volunteers like Fati, these gaps translate into long delays, incomplete treatments, and patients they cannot always save.
She remembers one case that still troubles her.
“There was one client for whom there was no hope for survival, but after treatment, the person was fully cured,” she says. A year later, the same person called her again, coughing. Tests confirmed TB for the second time, and treatment began.
Then conflict broke out. Movement was restricted, and the patient was unable to complete the second treatment cycle.
“As of now, the person is still suffering from the cough,” she says. “But when you pick the sputum, the GeneXpert will give the result negative, which I am still looking for a way forward on how to help the person.”
For Fati, surviving TB wasn’t the end of her story; it was the beginning of a responsibility she now carries across a district where distance, conflict, and scarce machines/resources determine who lives long enough to be diagnosed at all.
