THE CURSED POOR:MEDICINE IN A WEST AFRICAN COUNTRY

 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 (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 (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 may 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 (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 (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 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 (Photo: Kwei Quartey)

You might notice a floor-standing fan at 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.

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