The Ghanaian Health System: Hoping for A Better Tomorrow Without Trusting in Hope, Dr. Teddy Totimeh

Africa Barriers to healthcare Global Health government and politics Health System Weaknesses Healthcare Equity Public health Policy

When I saw the CT scan my heart sank. The beautiful symmetry that the brain has, the different shades that white and grey matter imprint on the LCD screen were gone. The lines that divide the electrical generating cells, from the transmitting cells, were gone. This was the aftermath of battle, and the brain cells had lost the ultimate war. And now even as the person’s heart and lungs worked together in the unison that is life’s rhythm, the brain was gone. Life had ended. And there was nothing that we could do about what was going to happen in the next few days.

Brain cells are fuel hungry. They are the choosiest cells when it comes to fuel. Unlike other cells, they will not use any alternative, when oxygen fails. The cell organelles fail, the mechanisms for maintaining the cell walls are overrun, and they rupture and disintegrate. It is for this reason, that the dividing lines exist. Nerve cells and other cells never mix. Their sustenance depends on very different environments. The central nervous system takes a quarter of the body’s blood supply, and yet looks off-white, because a barrier exists between its cells, and the body’s cells. The brain cells produce, harness and distribute electricity, instructions, the body’s cells actualize the instructions. And it is this collaboration that keeps the body going. And there are rules. A brain cell would never go to the leg to quicken steps. It would run out of oxygen long before the journey began. Everything useful about humanity, depends on the power of this partnership.

CT Brain Images of a Child

It is the same for society. It’s the same for all human endeavors. There must be clear lines between the management of power, and the management of resource. The people who populate the corridors of power, and vision, and intent, cannot also run the machines that clean the gutters, simultaneously.

The healthcare system in Ghana has become topical in the last few weeks. It is a story of failure, great need, and unused resources. In the root of its failure to thrive, is the blurring of lines, between those who manage the power, and those who manage the product. It is all service, but very different abilities are required, for the different components of health care. The people that maintain these two different environments, must be purpose trained, custom built and intentionally cultured.

Maternity Ward in a Ghanaian Hospital

That we have failed over decades to manage an elusive product: good health, is testament to a journey peppered with good intentions and ineffective actions. I have walked this path, for most of my adult life. I have smiled at the good intentions, and suffered the ineffective actions, seen the consequences of the poor decisions made by the people who run across the lines. It is difficult to look forward with hope. It is difficult to see the same shadows that familiar trees have cast, and refuse to acknowledge the very trees that cast them. It is difficult to keep engaging with a world which solved the problems we now face, decades ago. It is difficult to keep one head’s up, keep telling people who want to walk away and get treatment somewhere, to stay, and do it here. In this place where health is second place, to politics, to death, to V8 powered engine cars.

I have been listening to to the healthcare debate on various morning shows on my way to work. Driving to work in traffic, on our narrow streets, dodging the lawless motorcycle taxis, avoiding the pavement-less pedestrians. Driving to work in the healthcare system that I have the responsibility to actualise. I am all the way down the pecking order of the healthcare provision pathway. I live through the decisions. I see the struggle of the patients. I experience the daily need that results.

It is difficult to listen to Members of Parliament joke with a tour guide, trying out the monitors in an enhanced care ward. One reassuring his constituents that he was fine. Even in the hallowed enclave of the abandoned High Dependency Unit, here was someone from the corridor of power, messing around in my alley. Staining my morning with the evidence of a country which has put health second for decades.

To everything.

By Dr. Teddy Totimeh a Pediatric Neurosurgeon who practices at the Greater Accra Regional Hospital in Ghana


A physician providing primary medical care to patients across the lifespan