My day job in Ghana is as a radiologist, teaching Radiology residents and radiographers. It is not long waiting lists for outpatient elective tests that delay getting an imaging study done here (as is often the case in Canada) but rather the ability of the patient and family to pay for the imaging test and its contrast medium. I have not been on the receiving end of major medical care so far in my life, so it is eye opening to get firsthand experience as a volunteer nursing aide helping to take care of one patient, in a medical system vastly different from the Canadian or American one.
I am experiencing a “cash and carry” system in a public teaching hospital that is not funded by government to provide all the “consumables” or a high level of staffing. This type of system is the norm I am told in West African countries. (Some private hospitals will provide the consumables and bill accordingly.) For example, last month I had to check – in person – at five different locations on and off the hospital grounds to get the required size of bladder catheter, for the patient mentioned above.
The physical and financial efforts required of family to just have on hand what is required on a daily basis to deal with a serious illness makes me better appreciate what the Canadian health care system provides. Canadians and Americans expect that the hospital will have on hand everything needed by the nursing staff. In neither place is the family responsible for obtaining the needed items for the tests or for dressing wounds. In Ghana, the family has to locate the needed test or item, often on its own. The family also provides extra hands to assist the nursing staff with all kinds of duties, including moving and transporting patients.
The usual procedure for obtaining “consumables” consist of making a trip to a designated cashier to pay in cash for the test or item, get a receipt and sample bottle/test tubes, bring the receipt/bottle back to the ward staff to get the blood drawn, then deliver the sample back to the lab and some days later return to the lab (sometimes more than once, because of processing delays), to get the results and bring the report to the ward. Now think about repeating this process a few times in a day in some instances, as new tests or consumables are required and making sure there is always enough cash on hand to pay for each item (credit cards or cheques not accepted by the hospital cashiers). One’s sandals are quickly worn out!!
In order to avoid being left with unused items and to lower the financial burden, small quantities are prescribed each time, making return trips for refills frequent. More wear and tear on the sandals!! Not to mention the time spent on these errands and away from one’s work and family duties.
In this period of the year dedicated to families, let us all be thankful for having caring relatives/friends/strangers in our time of need.
Two KBNF Board Members, Dr. Paul King (a neurosurgeon from Atlanta) and I (a neuroradiologist currently working at the Korle Bu Teaching Hospital), gave presentations at the weeklong 2nd Annual Medical Knowledge Fiesta in Accra in August 2012, held at the Ghana College of Physicians and Surgeons. It is the largest medical meeting held in Ghana, apart from the annual meeting of the West African College of Surgeons, which is held in Ghana about every six years – the last time in 2006. A brief report details some of its activities: Medical Knowledge Fiesta 2012.
KBNF also held a two-day neuroscience conference at the Korle Bu Teaching Hospital in June and provided staff and medical students of the John F Kennedy Memorial Center in Monrovia, Liberia with 1.5 days of presentations the previous week. The aim of all these presentations is to increase knowledge about neurological conditions and their management among health care workers, in order to improve the level of recovery of patients.
I just want to confirm that I am fine, following the terrible tragedy at the Melcom store in Achimota (a northern suburb of Accra). Melcom is a local “Walmart” with at least half a dozen stores around the country, and the only such type of chain I have encountered here so far.
The building collapse occurred between 9:30 and 9:45 a.m., just after opening. The store has between 50 and 60 employees. The building was rented by Melcom; it was apparently two years old and had apartments on the floors above the store. The CEO said on TV they are insured because the tenants have to pay two years of rent in advance (a usual practice in Ghana).
When I went to bed, four people were confirmed dead and 38 had been pulled alive from the building. Powerful lighting and heavy equipment was allowing rescue work to continue during the night. The vice president was at the scene in the afternoon and the president interrupted his campaign in the northern part of the country to return to Accra (elections are on December 7th). When I left the hospital just before 5 p.m., we had not received any casualties in the CT scan. (This could be partly because studies have to be paid for before being carried out. All health care here requires upfront payment). Today, Thursday may be busier than usual.
I am looking forward to Marjorie’s arrival on Friday evening. She will be staying with me at the flat for almost a month, while she trains nurses in neurologic assessment of patients and charting of their progress.
Today, I thought I would acquaint you with the fun of motorized travel around Accra. I do not have a vehicle of my own, but I just obtained an international drivers license from BCAA, just in case. Apart from walking, choices include taxis (every two of three vehicles on the road, it seems to me), large orange buses (for intercity travel only), tro-tros, call cars (i.e. shared taxis) and motorbikes. Keep in mind that the vehicle has the right of way (pedestrians and goats alike are very mindful of vehicles).
Motorbikes have become very numerous and their young male drivers do not respect any regulations (like red light, direction of travel in the lane they are in, number of people on the bike, helmets, etc). Motorbike riders love to snake their way between rows of slow moving vehicles, even if there is only a foot (or less) between the two cars or trucks. I am forever surprised that impacts are not seen on every trip I take. I know I would not have enough eyes around my head to avoid them, if I was driving.
Call cars are a kind of private car/shared taxi seating 5-8 people that takes passengers from A to B, each passenger paying a fee based on the distance travelled. The call car leaves from the designated station or depot when it is full and drops people at their request. It will pick up passengers on the way also and may travel routes not covered by tro-tros.
Taxis all look like, they belong to the same company as their front and back fenders (a.k.a. wings to the British) are painted a shade of orange. They charge a fixed fare (negotiable) depending on the destination/distance or an hourly fare, if hired for the day. They do not have meters. Seat belts are not often worn and are often defective. The driver owns or rents the taxi and spends at least 40 cedis a day on gas (petrol here). The price of gas has remained unchanged since my arrival in February (1.708 cedis per litre or roughly $0.90 CAD). The government through its National Petroleum Authority regulates the price of gas.
Tro-tros are the cheapest way to travel. They are very numerous and are the main way to get around for most Ghanaians who do not own their own vehicle. The name is apparently derived from the initial fee paid by passengers on this type of transportation (three pence). They consist of minivans or minibuses, (pickups sometimes too) transformed to be able to carry up to about 20 people. A seat folds down in the aisle at every row, to accommodate extra passengers. They usually have a religious motto/saying in their back window. They are privately owned, have a driver and fare collector/announcer (crying out the destination every time the tro-tro slows down). They leave the various “bus terminals” called stations when full of passengers and then drop off and take on people at designated pullout bus stops on their regular route. The fare depends on the distance and is between 35 pesewas and one cedi (i.e. currently 20 to 50 cents CAD) in Accra. Longer distances will cost more.
The most entertaining aspect of tro-tros is their usual physical state. They are in use until they can no longer be taped together and the rust has won. A Ghanaian equivalent to Red Green with his duck tape is lacking. (Many tro-tros would not be on the road in Canada, due to faults about almost everything). Their one redeeming quality, apart from the low cost, is that their speed is slow in daytime due to the volume of traffic. I am using them to go to the Koala or Max Mart supermarkets for groceries. My Ghanaian housemate George helps me carry the bags home. That is George in the photo beside the tightly packed tro-tros at the Tema station on our last venture into central Accra.
Halloween is now upon us; I saw a small poster with a jack-o-lantern in the Sony store where I bought a DVD player. Halloween it is not celebrated here as many people still believe in witches and spells and awful deeds still occur because of these persisting beliefs; even though the number of churches and mosques and the abundance of clergy in Ghana would suggest otherwise. I suppose it is difficult to eliminate centuries old ways.
I will be spending the Christmas holidays in Ghana. The Orca furniture store (the whale shape is OK but the black and white markings are not true to nature on their logo) was busy assembling artificial Christmas trees on Saturday and Santa with sleigh, reindeer and all the tree trimmings were in evidence. I hope to witness true Ghanaian Christmas traditions (rather than the familiar North American or British ones).
Bye for now.
I had planned to take it easy and visit many BC friends during my recent three-week trip to Vancouver at the end of September. A lot of unexpected medico-legal work had to be completed however, including translation of a patient chart from French to English, so I felt like I had roller skates on most of the time. I apologize to all the people I had planned to have coffee with. I will try again in February, when I next return to Vancouver.
I did manage to participate in the first ever KBNF “Walk for the Bu” a fundraiser held at Bear Creek Park in Surrey on Saturday October 6th. I sincerely thank the Retired Doctors Coffee Club members who sponsored my 5 km walk. The weather was absolutely gorgeous during the whole three weeks, truly an “Indian” summer to remember during the monsoons that will surely come this winter. (Some of you will no doubt remember surviving record Vancouver rainfalls in the winter of 1979 and 1980.)
My Accra bound luggage consisted of orthopedic equipment, courtesy of the Compassionate Warehouse in Victoria; sterile burs and surgical blades, courtesy of KBNF member Peter Easthope and the UBC Animal Lab; many Radiology textbooks and a large number of classic movies and children’s shows on DVD. It is possible to play DVDs on the TV in the CT-MRI waiting room. I am trying it out on Tuesday mornings when Anesthesia is booked to sedate children. I hope to lessen the children’s stress.
The hot weather (28-32 C) has returned to Accra, after more than two months of being comfortable (i.e. 23-27C). I played one of the DVDs, “White Fang to the Rescue” at home, in the hope that the sight of lots of snow would help me cool down. This 1974 movie is ITALIAN, dubbed in English!!! White Fang was played by a (or many) very smart German shepherd. I wonder what Jack London would think. (The slight breeze and some homemade ice tea helped me a bit but I decided I was not hot enough to turn on the air conditioner.)
The new Head of the Radiology department is energetic and wanting to move it forward. I am enjoying working with him. The department is awaiting the imminent delivery of many new pieces of Japanese radiography equipment as well as the new CT and MRI. The new building is ready to receive them. Six new first year Radiology residents started on October 1st, enlarging the group to 18 residents. My PowerPoint presentations are getting another use.