There is a certain reality that one must accept as a health worker in Ghana, as there is a truth to be assumed. The truth is health work is a poorly managed space in Ghana. It is a Wild West on this side of the economic divide. Though there are some good aspects, they are regularly threatened and overshadowed by the bad. This is my working space, and I see this truth first hand. Here, there are patients who cannot afford what we can provide; there is the government that cannot afford staff to provide the range of medical care that the people need, and finally, there are staff that work in an environment rigged for failure. Patient death is an overly present outcome. Morbidity is rampant enough to merit nil reportage. Mortality limitation is the frontline war and morbidity prevention is the battle we lost long ago.
The health space in Ghana 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 to patient, why working with bare minimum is worth anything. In an environment of nonstop improvisation and adaptation, the high standard of care is sacrificed for survival. Quality of life can be a distant concept in the face of life/ death decisions. To want something better for our health system is to isolate yourself. To speak about better standards for our healthcare is to be a lone voice. To swim against a pervasive culture of waste, nonlocal decision making, and inexistent client rights, is to daily face this question: “Is this swim against the flood worth anything?”
Half of Ghana’s population are under the age of eighteen (18) years. Our burden of non-communicable diseases 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 organisations, as noncommunicable diseases are a growing and developing problem, and yet, not an emergency. We have a National Health Insurance System that covers communicable diseases that are already taken care of by international organisations, completely neglecting non-communicable diseases and trauma care. The health insurance system is funded by sales tax that everyone ultimately pays and yet, Ghana has been able to create a deficit.
When Ghana 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 were really not bothered about excellence in health care.
To work in this Healthcare system is to be devalued as a professional and deskilled. To treat fellow human beings in such an environment is to ask oneself about the sustainability of the impact one makes daily. 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 the prevailing culture – or lack thereof. The strategising needed to solve our problems is lost in the firefighting that ensures survival one day at a time.
The country does not need to export health workers – they are leaving on their own. They are already trudging the corridors of foreign consulates, and settling in the numerous systems that are extremely organised; 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 organisation 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, and worthy of being sheltered from the breaking point.
By: Teddy Totimeh
Medical Doctor,
Ridge Hospital – Accra, Ghana
