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Opinions Wed, 30 Sep 2009

What Can We Do to Improve the Quality of Our Health Care System?

Wherever we presently reside –whether in Ghana or in the diaspora-- all we Ghanaians have relatives by blood or marriages and friends and acquaintances in Ghana. At one point or the other in our lives, some of us, our loved ones, or acquaintances have visited or will visit our hospitals for treatment. On many occasions, the experiences of these people are, might have been, or will be normal warranting no comments or cause for passionately calling on our Government and countrymen to join hands to help make our system better. Sometimes, however, the experiences are, have been, or would be anything but normal necessitating the harshest possible criticisms and clamor for all Ghanaians to help salvage the health care system from its downward slide. For these latter situations, objective on-lookers raise questions about the quality of our health care system and the ethical standards undergirding it.

Let’s ponder over our most recent past. Just think about the Late Peter Ala Adjetey and Kweku Baa Wiredu, and the list expands *ad infintum.* Because of the limitations of the Ghanaian medical system, all these people who have put in a lot to help sustain our country have had to be transported into other countries, including South Africa, for treatment. Was this the vision that our founding fathers envisaged for our country? Or, is that what we should hail and pursue? I will absolutely respond to this question negatively. I know what our public hospitals -- the 37, Korlebu, Tema, Okomfo Anokye, the La, and other polyclinics , etc.– were in the sixties and early seventies. I know that, as part of our First President Dr. Kwame Nkrumah’s vision, these institutions were to be of first class stature, catering for all patients with standards paralleling the best in the world. I know also that, by the standards those days, these hospitals had all the markings matching or striving to match services rendered by the best medical systems in the world at the time. Thus, our seriously medically challenged countrymen and women did not have to be transported abroad for treatment.

What has our health care system been since 1966? What have we done to cope with current medical advances, what have we left undone, and what can we do to cope with current challenges? I am sure that any objectively thinking Ghanaian would feel ashamed to answer these questions because, from our truest conscience, we cannot describe the situation any other way except in the negative because we have failed to uphold Dr. Nkrumah's ideals to acquire the cutting edge technology and equipment, let alone the basic equipment and quintessential training and skills.

Several years ago, one of our leaders described our hospitals as serving no other purpose than being the last stopping stage on one’s journey to eternity. Frankly, that observation was apt because we lacked emergency services at the hospitals, including beds, modern and adequately trained professionals for medical emergencies. Regretfully and rather depressingly, however, the picture then and the picture that exists today is gloomier, at least, as recently exemplified in the plight one Ghanaian family, reflecting the difference between night and day or that between light and darkness, raising the questions as to what we are doing wrong and what can we do to break this gloomy trend and create a better future for our dear country and countrymen and women?

I have always admired and cherished the standard hoisted by one U.S Senator who blueprinted the standards for ascertaining the true character of a country. As that Senator aptly noted, the true character of a nation is discerned from how it treats its poor, sick, elderly, and disabled persons. Indeed, in his view, which I think is unexceptionable, any country having the true moral fiber treats all its people with the greatest care and dignity. Coupled with the pathetic story of the previously mentioned Ghanaian family, the teachings of the Senator are what have prompted me to write this piece.

Briefly, the sad and unfortunate story of the Ghanaian family is that one member of the family suddenly started exhibiting symptoms of mild stroke. The family members rushed the party to one of the supposedly best hospitals in Ghana, where the party was immediately taken to the emergency room. Everyone was thankful and impressed by the in-take procedure. However, the treatment beyond the in-take left out a lot of what was desired under the circumstances. The family members do not claim to know all about medicine. One thing they know, for sure, though, is that when a person shows symptoms of stroke, the progression of the ailment is arrestable within the first few hours. They know also that if the stroke is caused by hemorrhaging, expeditious surgical intervention can stop the bleeding just as the right medication would ease clogging if the stroke emanates from blood clog. Thankfully, in this situation, the doctors decided to have a CT scan done to determine what the cause of the stroke was. Unfortunately, however, rather than doing this expeditiously in keeping with the standard practice with strokes, the doctors scheduled the CT scan to be done two days later. No amount of efforts by the family members to compensate the doctors for expeditious action to forestall the unexpected mishap was heeded. Adding insult to injury, the CT scan, done two days after the admission of the patient when irreversible fatal damage had been done, was not analyzed until one week after the test.

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Nor did the patient’s problems end with the CT scan impasse. Indeed, and rather outrageously, the hospital discharged the cognitively impaired patient with tubes in the nose leading into the stomach for days only to be readmitted two days later after the family raised questions about that apparent unethical and mishandling of the patient. Unsurprisingly, the patient died the following day. This avoidable and shamefully unspeakable loss of a fellow Ghanaian's life clearly is reprehensible, raising questions about what kind of training is afforded our medical practitioners. In the developed world many a physician would lose the privilege to practice medicine for this stark irresponsibility, *See* *Levy v. Board of Registration of Medicine,* and / or even steep liability for deviation from accepted medical standards and concomitant medical malpractice.

I am sharing this experience with you because it happened to a very close acquaintance and because I believe it is the responsibility of all of us to complain about such mishaps and do whatever we can constructively do to help improve our system. Today, it is a very close acquaintance; tomorrow, it may be me; next time, it may be you or anybody else. If even the Honorables, the Late Peter Ala Adjetey and the Late Kweku Baa-Wiredu, etc., have had no other option but to choose between our ill-equipped hospitals and hospitals elsewhere in the world, any of us and / or our relatives and acquaintances would undergo similar experiences sooner or later. My question now is: what should we do as Ghanaian citizens? And my proposed solutions are as follows:

1. We should all put pressure on our government officials by sharing these experiences as they arise, hoping that they would be woken to appreciate the gravity of the problem and use our resources productively to prioritize and revamp such vital aspects of our socio-political system as the health care sector. If we can spend hundreds of millions on our fiftieth celebrations, our presidential jets, palace, per diems and perks for parliamentarians, we should be able to sacrifice to improve such vital aspects of our human socio-political and economical capital as our health care system, because, as the Gas put it, "mii tsiimo ake kpaa ble," literally meaning we work efficiently when we are healthy!

2. Ambulance service is woefully needed everywhere in the country. Thus, in any type of emergency, including automobile accidents on the roads and sudden heart attacks in our residences or places of work, lives that could be saved are lost either because there are no emergency services and trained professionals to render first aid services. One way to tackle this problem is for all Ghanaians to consider chipping in what we can afford, either financially, logistically, or, at least one month-per year voluntary services to help. To this end, Ghanaians in the diaspora should consider (a) serving voluntarily in our areas of expertise, at least, once a year in any part of the country, especially in the Northern and Upper Regions where services are woefully needed, and (b) constituting non-profit organizations and using them as vehicles for raising funds to help alleviate the challenges plaguing the health-care system by contributing for training of emergency medical and ambulatory services throughout the country. As a practical matter, daunting questions may be raised about accountability for funds raised, who to funnel it through in Ghana, etc. While we can share ideas through debates on the issue, I will suggest that funds collected should be funneled through the head of either the ministry of public health, or that of any or all of the public universities under a scheme where such heads would be required to render annual or bi-annual accounting on how they spend the funds funneled to them for these purposes. Correspondingly, a website should be opened for anyone who contributes anything to these nonprofit groups to register whatever they donate so that Ghanaians can use those pieces of information to check and ensure that the donations are used responsibly. We should provide these services and contributions now when our dear country is in the woods and continue to do sot until the country gets on its feet in the medical area because Ghana is truly all we have and nobody will do it for us.

Please, take this as an invitation for all our heads to come together with realistic and implementable ideas by which we can break with the current seriously challenged system. In doing so, we should be pragmatic, objective and serious, without injecting tribalism and politics.

By Dr. Nii Otu Quaye

Columnist: Quaye, Nii Otu
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