Trauma ER at Military Hospital
THE CURSED POOR:MEDICINE IN A WEST AFRICAN COUNTRY
On June 30, 2018 | 14 Comments

                A GLIMPSE INTO THE PRACTICE OF MEDICINE IN A WEST AFRICAN COUNTRY

The West African country of Ghana continues to show respectable GDP growth rates.

West African country of Ghana sits centrally on the Gulf of Guinea

West African country of Ghana sits centrally on the Gulf of Guinea (Shutterstock)

 

 

Yet multiple studies show that Ghana’s income inequality rate continues to accelerate. Talk about the 1% movement–in Ghana, the income gap between rich and poor is so severe it would be more like the zero point something percent. An ordinary citizen interviewed by a local radio station in Accra said he didn’t know what GDP was and he was shocked that Ghana’s was one of the better ones on the continent, because it sure didn’t feel like it.

An area where this inequality is evident is in medical care. Private healthcare facilities are associated with shorter wait times and increased patient satisfaction, but they are expensive and accessed only by those with money. The National Health Insurance Scheme, which is supposed to help the poor pay for medical care, has failed to fulfill its mandate and, ironically, wealthy people are more likely to enroll.

I had the opportunity to personally see medical care in action in Accra (the capital of Ghana) when the sister of a friend of mine–we’ll call them “Mary’ and “Jason” respectively for the purposes of this blog post–was in a bad vehicle crash when the wheel of a tro-tro (public minivans transporting 14-18 passengers) came off while the tro-tro was traveling at top speed. Mary suffered a severe pelvic fracture, multiple rib fractures, and a punctured spleen. Miraculously, she was brought to the trauma ward at the Military Hospital, one of Accra’s better public hospitals. “Miraculously” because emergency services (ambulances, fire, etc.), although improving, are still sluggish in arriving.

Trauma ER at Military Hospital (medicine in a West African country)

Medicine in a West African country: Trauma ER at Military Hospital (Photo: Kwei Quartey)

 

 

To stop internal bleeding, she went straight to surgery for a life-saving splenectomy, and from there she was admitted to the ICU. I had not arrived in Ghana while Mary was in the ICU, but Jason relates that the care was of high quality, and I have seen a comparable ICU elsewhere in Accra and it was up to international standards. However, the cost of care in the ICU was the equivalent of about $170 a day, and that was just the base rate. Mary was in the ICU for 10 days, so a total of $1700.

You will be shocked to learn that many items like IV fluids and certain essential medications used during ICU care must be purchased on a daily basis by the patient’s family members. The items are generally written out on a prescription form in the morning and the family must obtain them either at the Military Hospital pharmacy or, if unavailable there, elsewhere at outside pharmacies. Here is an example of one such prescription for Mary:

Rx for IV fluid and medications(medicine in a West African country)

Medicine in a West African country: Rx for IV fluid and medications (Photo: Kwei Quartey)

 

 

As an example, the first item, Fragmin, is vital to prevent deep vein thrombosis (DVT), which Mary was at high risk of developing because of the pelvic fractures and her immobile state. A 6-day supply cost about $200. It had to be given for Mary’s entire stay in the hospital in the ICU and then the ward, which was a little over 3 weeks, i.e a total of $700. Also expensive was Pethidine (called Mepiridine in the US and not used much anymore) was for pain, which as you can imagine, was intense. I saw Mary’s pelvic film and CT scan and it looked like a jigsaw puzzle of fractures. (The CT scan was done at a private facility as the hospital’s CT and MRI were both down.) The other items are IV fluid, antibiotic, and anti-ulcer medications. Bear in mind that all the items may not be available at one pharmacy. Jason had to obtain many of these items either daily or every other day, meaning a lot of going around town to find pharmacies that stocked them–sometimes as many as five or six different places.

Maneuvering the gurney into the ultrasound room (medicine in a West African country)

Medicine in a West African country: Maneuvering the gurney into the ultrasound room (Photo: Kwei Quartey)

When Mary moved to the ward, doctors ordered a doppler ultrasound of her swollen left leg. Moving her was an exercise in torture because of her 10/10 level of pain, and my suggestion that they premedicate her was dismissed. The radiology waiting area was pretty packed, and the ultrasound room was oddly almost too small to easily accommodate a gurney.

 

Patients patiently waiting (medicine in a West African country)

Medicine in a West African country: Patients waiting at x-ray department (Photo: Kwei Quartey)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

As in many hospitals in the UK (still), the wards contain several beds per large room. This obviously reduces privacy considerably, and it’s also upsetting for patients when a fellow patient dies, because it becomes quite obvious even when curtains are drawn around his or her bed. Males and females are not segregated. Very curious to me was that medications, once obtained, were generally kept at the patient’s bedside, and that included opioids like codeine. However, that needs to be seen in context, since cough medications with codeine are available without a prescription. Incidentally, Ghana has its own opioid crisis with Tramadol abuse.

Family members at a patient bedside on the ward (medicine in a West African country)

Medicine in a West African country: Family members at a patient bedside on the ward (Photo: Kwei Quartey)

 

 

You might notice a floor-standing fanat the foot of one of the hospital beds. That belongs to a patient. There is no air-conditioning and if you want to be cooled off, especially during the sweltering heat of the day, you need to have relatives bring in your own fan. You might be the envy of other patients, though!

The happy ending to this saga is that Mary survived, is out of the hospital and ambulating with the help of a walker. The bill for the ward stay was equivalent to $1880. Add that to the ICU bill of $1700 and you have $3580. Don’t forget also the massive bill for the medications and IV fluids. This is a lot of money in Ghana and it is cash. Forget about credit cards, my friends. The point is that if Jason and family had not been able to come up with these kinds of funds, the outcome for Mary might have been very different, up to and including death. By the way, if you can’t pay your final bill, you can’t leave the hospital and the bill will continue to accrue. I have no idea what the endpoint of such an intractable situation would be.

Comments14
Hal Womack Posted June 30, 2018 at7:23 pm   Reply

Thanks to Doc Quartey for the fascinating story from the Ghana hospital!

Betty Tyler Posted June 30, 2018 at7:39 pm   Reply

Thanks for this eye-opening account. Hope “Mary” continues o heal.

Kwei Quartey Posted August 23, 2018 at2:56 pm   Reply

Amazingly she has done well! She can now walk unassisted and almost all her pain has resolved.

MARY KOEPP Posted June 30, 2018 at7:50 pm   Reply

Been there, done that and almost lost my foot when a tro tro knocked me down and then ran over me. If the pastor I was with had not chased the tro tro and demanded that the driver stop I would have had no way to get to any medical facility. The driver picked me up and carried me piggy back to his trotro (van) and drove me to a building hidden back among twisty turney roads with a sign that said medical. I sat on a strait chair in a not-clean waiting room bleeding on the floor for what seemed like forever then was taken to a different chair behind a screen where some kind of bleach solution was poured on my foot which was pretty badly mangled. They had no bandage and no gauze. The doctor attempted to put 10 syringes of lydocain into my big toe. By number 4 I was screaming so loud and in such pain that the pastor demanded that he stop. My foot nwas wrapped tightly in a strip of cloth and I was told to come back in the morning for a clean dressing. The tro tro driver drove the pastor and me to a transfer station and once again piggy backed me to the van I needed for the 20 mile trip back to the seminary where II was a missionary teacher. The pastor got a name and number for the tro tro driver who ultimately made a payment of roughly $50 for my care. If I had been a Ghanaian, he never woiuld have stopped at all. Injury and death are daily occurances on the Ghana roads. with no liability enforced on these drivers.. After 2n trips to that same clinic for new dressing, we found me a better place at a university medical facility. Better only because it was closer. They changed my dressing in a room full of storage boxes and filthy chairs and floor. Miraculously- (Absolutely) what they did do right was keep me from getting an infection because the dressing was so tight and changed daily by a friend at the seminary.. The third day my travel insurance kicked in and arrangements were laboriously made by telephone for my care with a a high-dollar- neighborhood clniic in Accra. Sterile, white and organized with real nurses and doctors in uniforms and with clean hands The difference was more than day and night, but still evertone I saw said “may have to amputate” the new, AC clinic van came 30 miles daily to bring me to Accra for x-rays, ultrasound what ever American toy was on hand. It was finally determined that there were no broken bones and that it would be fine to walk with a cane.Interestingly enough the orthopedic surgeon who told me that also showed me some blurry pictures on his cell phone and told me me he was sorry to have to tell me that though the foot would heal the leg was full of a huge cancerous tumor. The picture was a blur my name was not on it. My friends and I prayed that away immediately. Clean and fancy doesn’t mean the care is any more advanced. I finished the last two weeks of the semester climbing a flight of stairs to my classroom with the help of a cane. Went to the doctor in Colorado where I was told the foot might have to be amputated but I would have to wait until the foot specialist surgeon came back from skiing vacation. That doctor and God saved my foot. The Achilles tendon had been floating around in my heel for 4 weeks completely detached from ankle. Two years later I have about 90% use of my foot and ankle and the cancer-free leg. Yep, If you are going to Ghana, be double sure your travel insurance covers medical or you will end up on a cot with a filthy foam mattress and whatever comforts (including a sheet) and meals and water your family is able to bring you.

Kwei Quartey Posted July 9, 2018 at9:30 pm   Reply

Thank you for sharing that harrowing experience. Prayers that you heal as much as is physically and emotionally possible.

Stephen Davies Posted June 30, 2018 at7:57 pm   Reply

Yes I have lived a similar experience in 2015, (I was visiting my mother in Ghana), when an Uncle of mine was admitted to the 37 Military hospital. What I found unbelievable that males and females share same wards. I was take aback.

Kwei Quartey Posted July 9, 2018 at9:34 pm   Reply

Yes, concepts of privacy are radically different there. It is something of a luxury.

Barbara Albin Posted July 1, 2018 at1:40 pm   Reply

I agree, eye opening. Think you had mentioned this type of medical delivery before. My cousin recently visited a friend on the Isle of Mann, her friend a recovering cancer patient had 5th world medical care and had to go to England to ge Cancer care, but pay for it t. She is now broke. The hospital in Sacramento charged 308,000 for my husband’s open heart and aortic valve replacement. Add another 100,00 for two emergency returns. Outrageous pricing, fortunate to have Medicare and a supplement plan. Plus, he still has 48 rehab sessions ahead.

Kwei Quartey Posted July 9, 2018 at9:33 pm   Reply

The irony is that right here in the USA it is possible to go bankrupt trying to pay for expensive medical care.

Jennifer Moore Posted July 2, 2018 at7:43 am   Reply

This is so shocking and sad. Everyone should be able to get the medical help they need. I’m so glad that “Jason” was able to get the money to get “Mary” her treatment. I hope she recovers fully.

Ishola Gbadegeshi Posted July 2, 2018 at9:53 am   Reply

I am impressed with your level of dedication by bringing the issue of absence of adequate healthcare service in Ghana to the attention of the world. Wishing Mary a speedy recovery.

Renee Posted July 2, 2018 at12:59 pm   Reply

Thank you for sharing this interesting article. It is so unfortunate that poor people always carry the highest burden.

Susan Wisecup-Agbedzinu Posted August 20, 2018 at9:01 am   Reply

I was a patient at 37 Military when I developed severe bursitis in my hip during a visit with friends in 2016. I would not recommend the hospital for anyone. The care by the nurses’ aides was exemplary; however, nursing care was poor to nonexistent. Vitals were done every shift by the aides but at no time during my 2-week stay was I ever assessed by a nurse and to top it off, I had an indwelling urinary catheter (same one for the whole time) which was badly inserted and leaked constantly. I left for my flight home with my Foley still in and nothing but blood in the collection bag. Needless to say I had a raging UTI. My attending, a recognized trauma surgeon, when I politely refused an MRI which I could not afford and which would have to be repeated when I returned home anyway, actually ordered my pain medication to be d/c’d in retaliation, leaving me in severe pain for the balance of my stay. I was never reimbursed by my insurance company although I brought every receipt home, except for ambulance charges, which I was refused a receipt for. I will be visiting Accra again but will never allow myself to be hospitalized there again.

Kwei Quartey Posted August 23, 2018 at2:59 pm   Reply

I agree, unless absolutely necessary, stay out of the hospital. I don’t understand the rationale for admitting you for bursitis.

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