There is a certain reality that one must accept as a healthcare worker in Ghana. There are certain truths to be assumed. In our environment healthcare is a poorly managed space. It’s a Wild West on this side of the economic divide. There are some good aspects, daily threatened by the bad. This is my reality, there are the patients who can not afford what we can provide. And then the government which cannot afford the staff to provide the range of medical care that people need. And the staff that work in an environment rigged for failure . Patient death is a an overly present outcome. Morbidity is rampant enough to merit nil reportage. Mortality limitation is the frontline war. Morbidity prevention is the battle we lost long ago.
It is an environment that devalues both the client and the practitioner, at every level. The practitioner has to explain, over and over again to self and patient, why working with bare minimum is worth anything. In an environment of nonstop improvisation and adaptation, standard of care is sacrificed for survival. Quality of life can be a distant concept, in the face of life and death decisions.
To want something better for our health system, is to isolate oneself. To speak about better standards for our healthcare is to be a lone voice. To swim against a pervasive culture of waste, non local decision making and nonexistent client rights, is to face daily that one question; is this really worth it?
This country has half its population under 18. Our burden of non communicable disease is a fraction of what developed countries have. The top killer of our young people is traumatic brain Injury from road traffic accidents. The significant communicable diseases are all taken care of by international organizations. The non-communicable diseases are a problem, and a developing burden, but not an emergency. We have a National Health Insurance System (NHIS) which covers the already covered communicable diseases and not one non communicable disease. It also does not cover trauma care. It is funded by sales tax that everyone ultimately pays. And yet we as a country have been able to create an insurance deficit.
When we failed to run a successful Insurance system as a country, we cemented a death wish for quality healthcare. By running it aground, we lost the only body that could have held the Ministry of Health, the Ghana Health Service and the Health Institutions accountable. We lost the single body that could have promoted excellence in our hospitals by solely paying for treatment that met certain standards. When we run NHIS aground we declared as a country that we really were not bothered about excellence in health care.
To work in this Health Care system is to be deskilled as a professional. To treat fellow human beings in such an environment is to daily ask oneself about the sustainability of the impact one makes. There is no question about impact. In an environment of failure, every little positive move, is impactful. The question is always how to keep from being overwhelmed by prevailing culture. The strategizing needed to permanently solve evolving problems, is swallowed in the firefighting that ensures survival one day at a time.
Health workers are leaving. The country does not need to export them. They are already trudging the corridors of foreign consulates, and settling in the numerous systems that are so organized, they are already filling vacancies for 50 year scenarios. The greener pastures may not be as green as they are made up to be, but are definitely better managed and more rewarding.
Those who remain, those committed to working the remnants of the organization that we have, are battle hardened health warriors, built to survive anything. Making decisions on the fly with the understanding that nothing is assured, and help will not arrive. The people who have made this system stand the test of time, with all its failings, are worthy of deep respect.
Such individuals are also worthy of being sheltered from their breaking point.
By Teddy Totimeh a Pediatric Neurosurgeon who practices at the Greater Accra Regional Hospital in Ghana
Clinic Scene Photo – Courtesy of Julie Dean, University of Georgia
Motor Vehicle Accident scene – Courtesy of SBS News