Things you didn’t know about the hospitals in Northern Ghana
This post is a little off topic for my travel blog, however I feel that if you travel to many places, you will have definitely encountered a hospital visit or two. It is important for me to explain what is actually happening in many hospitals in Africa and especially in northern Ghana, travel is not always about the perfect sunset or the relaxing day you spent on a beach.
Having lived in Africa and been a patient at many hospitals for more than the last three years I thought I had a pretty good understanding of some of the practices and problems these hospitals have to face on a daily basis. It wasn’t until working for the NGO, Ghana Medical Help, in northern Ghana that I realised just how much is lacking in terms of facilities, medical equipment, education, organisation and professionalism within these hospitals.
I have witnessed varying degrees of cleanliness, patient confidentiality, sympathy and basic care.
I have no education in the medical field, but as an English educated woman I feel there are basic things screaming out to me as I delve further into the medical world here in Ghana. It is very easy to point fingers and blame the staff running these hospitals, but it goes way further right back to the government and its ability to educate and provide for these hospitals. Everyone perceives Ghana as an African country of success and in part it is; there are religious groups living side by side in harmony, it is mostly a stable country politically and compared to other African nations it has a reasonable economy. However the part of Ghana the world loves and knows is in the south and nobody ventures up to the north, not even the Ghanaians themselves. The government gives barely any of its resources to the north in comparison to the south, even the Ghanaians have a stigma towards the people of the north and this is partly why the hospitals are lacking so much in equipment and staff.
The NGO I am affiliated with here has been running for over four years, this year alone it has managed to fundraise over $100,000 to buy and transport basic necessary medical equipment to ten district hospitals in the Upper West and Upper East region. This equipment consists of things as basic as thermometers, blood pressure devices and stethoscopes, before the influx of these kinds of equipment a whole hospital might have had as few as one or two working thermometers between several wards and they are trying to treat thousands of patients in a day. Builsa hospital in Sandema has one doctor for around 95,000 patients; he is on call 24/7, meaning many nights in a week he is called out to do emergency surgery, before having to go back the next day to resume his daily duties. This man is the equivalent of a mother Teresa and must never sleep.
Let me start with staff at the hospitals, there are many nurses, a physician’s assistant for each ward, an anaesthetist, a surgical nurse and as I stated before, only one doctor. What is the level of education that these staff actually have though? This is not to say they are not capable but that maybe the level of education that they have received is just not good enough to really help patients in life or death situations.
Let me give an example:
A one year old child is admitted due to malaria, this child ends up needing a blood transfusion, however the vein is his arm is not receiving enough blood. The nurses are trying to find a vein in his scalp as his health is deteriorating quickly. The 4th year British medical students, who are on a placement here, suggest maybe a direct line into his bone would be better. The nurses agree and run off through the hospital to find the necessary equipment. During this time the baby crashes and needs resuscitation, the Physician’s Assistant turns to the British medical students and asks, “What should I do?” Obviously the reply is CPR, however not one of the staff knows how to actually perform this life saving act properly and the students are left to try to save this baby’s life. Unfortunately in this case the baby died.
Let’s now look at the things that were lacking in terms of medical equipment, education, organisation and professionalism within this hospital.
Firstly the equipment and organisation; why when a child is admitted to the ward are there very few mosquito nets in the children’s ward? These are children that already have a compromised immune system. Why was the equipment necessary to give a blood transfusion directly into the bone not on hand within this ward? Is this a case of them not having the equipment, or is this the case of poor management and organisation within the ward? I should imagine probably both.
On terms of professionalism; there are no curtains surrounding the beds for privacy. When a patient crashes or needs and invasive procedure why are there no curtains to pull around the beds? Firstly for the other mothers in the children’s ward, seeing another child crashing and needing resuscitation is only going to add to their stress and worry for their own child. For the patient, especially more for adult patients, curtains are necessary as privacy when being examined by a doctor. Quite often my students have been told very loudly by the staff, “This patient is suffering from this and this one from that” so all other patients and visitors around can hear. There is no patient confidentiality at all, one man even had his scrotum inspected in front of all the patients and visitors in the ward.
Looking at education; in the United Kingdom absolutely every single hospital worker at whatever level will be taught about CPR and basic emergency lifesaving skills. Are these lifesaving skills lacking because most of the staff in these hospitals were educated in the north? Meaning would they receive a fuller, more intense education if they had been educated down south in the capital city, Accra? I feel even basic skills such as washing of hands more than once in a morning and when washed, it being done in a proper way, these are areas that need attention. They even have posters all around explaining what are the expected hand washing protocols; this has to be an education issue.
Could this baby’s life have been saved? Yes most likely is the answer, again with what I have stated above, it is not one person’s fault, it is a combination of several areas that need to be improved as a whole to give an overall better place of care to its patients. I could write on more and more about specific cases;
The anesthetist deciding not to come to work one day, with no one to take his place, leaving patients to endure C-sections with little more than gas.
Abortion practices that would probably compare to those in the early 1900’s in Europe, with no anesthetic given or sensitivity to the women patients.
Wrong diagnosis’s of conditions and as a result wrong medication given out.
Non-existent pain relief for post operated patients.
An X-ray machine unused because the person trained to operate it went to another hospital and was never replaced.
This list could go on and on.
What I have evaluated from my short time here are that all areas such as facilities, medical equipment, education, organisation and professionalism within these hospitals needs to be looked at. For the NGO, Ghana Medical Help, I believe that one area they are definitely improving is the availability of equipment. However I feel that the next step is to find a way with working with the government to improve the education system of medical staff and through that other areas such as organisation and professionalism within the hospitals will benefit.
The medical students who were here for 5 weeks on their elective have found at least two areas where education could be improved easily.
Firstly the availability of medical books for staff to have access to would help with diagnosis and treatment. Navrongo district hospital would like to set up a library system of books so staff can take them on loan and try to learn more. One of the British medical students had a British National Formulary book which all the staff were fighting for, these books are constantly updated in the United Kingdom and the older additions become obsolete, can there not be some kind of program where these obsolete books can be sent to the hospitals here?
Secondly the staff at Navrongo hospital are desperate to have some simple training once a month on areas such as resuscitation. I think starting with a basic lifesaving workshop would indeed have huge effect, the staff will be more confident in their skills, leading to correctly helping patients rather than looking around at one another in panic.
The NGO Ghana Medical Help is aware of all the issues that I have raised here and is also working towards developing the education of the staff as well as supplying medical equipment. It is an on-going learning curve for all involved and it can only improve if people are aware of the problems and are willing to help.
For more information or how to get involved below is the link to the NGO I have spoken about.