Doctors Need Curing
Elizabeth Ohene
If the plight of patients and the doctors and nurses that try to look after them is such a nightmare, how can a doctor be trained in such circumstances? Elizabeth Ohene examines the degeneration in Ghana's medical services.One of the most cheering pieces of news to have come out of Ghana recently was the announcement that 77 new doctors had been led in taking the Hyppocratic oath by the dean of the Ghana Medical School. Considering the fact that in the past two years rule of the Provisional National Defence Council (PNDC) the Universities in Ghana have not been opened for more than eight months, it ranked as one of the miracles in this sorely tried nation that doctors were still being produced. This, in spite of the fact that very few departments in any of the country's Universities, have more than a couple or so of their lecturers still living in Ghana. And in spite of the fact that Korle Bu Teaching Hospital has taken more than its fair share of the deprivations that have hit the entire country. Often when the woes of Korle Bu Hospital are being narrated, the only things emphasised are the terrible ordeals that a sick person has to endure at the hospital.
PRIDE
No drugs, and nobody is talking of any newfangled drug recently discovered to cure cancer, pain relievers, the common aspirin has become a nugget of gold being fought over, and when there is talk of a lack of equipment, the lament is not over the absence of dialysis machines for kidney patients; more often than not, the scramble is for syringes, cotton-wool, disinfectant and soap.Even though the prospect of being a patient in Korle Bu is indeed terrifying, it must be an even greater agony being a nurse or doctor in this hospital that was once the pride of West Africa. For, three years ago during the days of the Limann regime, doctors had already resorted to using the hand gloves meant for hairdressers using corrosive creams on ladies hair as surgical gloves. It was a dreadful situation and many properly denounced a government that could preside over such a state of affairs. But, the odd operation was carried out - when oxygen was available and when the hospital authorities could get some soap from the black market. Now that the evil practices of the bad old days have been eliminated from the revolutionary society, it would be a brave hairdresser indeed who would offer for sale to a doctor the disposable pair of gloves that come with her hair relaxing cream.
If the plight of patients and the doctors and nurses that try to look after them is such a nightmare, how can a doctor be trained in such circum- stances? When will a medical student ever get to hold a syringe in his hand or have the opportunity to administer an anti-malaria drug so that he/she will know how it really works? How does a medical student ever get to take exams in surgery when no operations are being carried out in his teaching hospital and how does he monitor the progress of his patient when the risk of infection is as high in the operating theatre and the ward as in the home from where the patient brought the infection? And who has time indeed for an enquiring student when heads of department of the teaching hospital are preoccupied with roaming towns to find food for their own children and pencils to take to school?
ANTICIPATION
The hard work and drudgery that make up the life of a medical student have always been eased by the special relationship that exist between the various year groups the pre-meds are always counting the days when they are introduced to the wards, the second years are always listening into the conversations of the third years with envy and anticipation to the day they witness their first delivery - the mysteries and joys of childbirth have given many a medical student on the verge of giving up, the strength to stay up the extra hour with his book. The shock of the first death has sombered down the most determined student and the supposed glamour of their chosen profession has always needed re-evaluation after that first post-mortem examination.The final years can hardly wait to become Housemen and to be called 'Doctor' by the members of the public and even though all housemen swear that they are the slaves in every hospital, they are always kept up with the excitement of daily new experiences and the knowledge that at the end of a year or two, they will be accepted as doctors anywhere in the world. Some would already have started eyeing critically the grey hairs of the consultants in their chosen departments and begin daydreaming about becoming consultants totally ignoring the long gruelling years between becoming a lowly medical officer and a qualified specialist surgeon. But why begrudge them, day dreams have never killed anybody and Korle Bu Teaching Hospital had acquired a reputation good enough to ensure that not only could a product acquit himself creditably anywhere in the world, a qualification from Korle Bu put a premium on their doctors in the marketplace.
NATIONALISM
When newly qualified doctors started leaving the hospital as fast as they were being produced, it became cause for concern in the highest levels of government and all kinds of obstacles were conjured up to put in the way of the young doctors the country was producing. Appeals of nationalism did not have much effect and as soon as they could, the doctors left. At first it was the senior ones that left, but the seniority declined until most of them started leaving as soon as they finished their housemanship.Now that the newly qualified doctors have nothing and nobody to look forward to and no new batch behind them to look up to them the magic barrier of the time Ghana's new doctors flee the country has been broken. The news that 77 new doctors had been sworn in was not strictly correct; 77 students had indeed passed the exams and qualified to be sworn in. But more than half that number did not even bother to attend the ceremony; they did not even come to put their housemanships behind them before going the way of their predecessors, and taking their oaths.
Since the PNDC has still not made up its mind about the possible reopening of the Universities, those who were at various stages of the medical school, have no way of knowing if they will ever become doctors and it is known that many of them have already faced up to the reality of changing their chosen careers.
SHORTAGES
A few intrepid young doctors have elected to stay on and their experiences would make the famed bare-foot doctors of China look very ordinary. They are putting up with everything, including shortages of every imaginable thing - even the absence of sanitary towels and cotton-wool in the delivery rooms - they have learnt to use and steel themselves to the sight of women using rags to mop up blood; but the transportation breakdown in the country proved impossible to endure. Even the most committed and nationalistic young doctor needed to move around, at least to get to the hospital.A caring PNDC government therefore recently got some Volkswagen cars for the young doctors to ease their plight and make their lives a little more tolerable; the same caring government told the young doctors they were entitled to eight gallons of petrol a week instead of the four a week that everybody else was entitled to. The only snag in such an admirable arrangement is that each VW car is being offered to the doctors at C178,000 (one hundred and seventy-eight thousand cedis!) Now, the PNDC is not trying to make any money out of the young doctors, C178,000 is the cost of the cars to the PNDC. Your average young doctor after the recent salary adjustments in the country, takes home €1,200 a month.
The doctors raised a little problem about the cost of the insurance premium they would have to pay to be able to insure the car comprehensively as required by law, the money for the cost of the car itself? - well, the teaching hospital (i.e. the government of Ghana) would advance €178,000 plus interest as a loan to the doctors. The government offered a way out of the dilemma - why don't we licence the cars as government vehicles and you I still have use of them. Thanks very much, the doctors said, and have our wives assaulted by PDC's in the market for driving an official vehicle to the market? No thank you very much!
Result? Deadlock. The doctors are driving the cars now, they don't belong to them, but since nobody can take the decision, the problem has been swept away in the hope that it will disappear.
WIZARDRY
But that is not the end of even the immediate problem that faces the doctors about the cars. They are allowed eight gallons of petrol a week at €35.00 a gallon, that is C280.00 a week and if my arithmetic is correct, the cost of petrol to him in a month is €1,120.00 in other words almost his entire salary for a month; engine oil, distilled water etc, cannot be in the reckoning. As for the cost of the car, C178,000 if the hospital should take ALL of the doctor's salary every month, he might finish paying for the VW in about 15 years; if the interest is waived. Little problems like food, clothing, housing and family obligations are not in the reckoning.Surely, brave programmes and supposedly economic wizardry are supposed to have some semblance to reality. How is a young doctor who is willing to suffer and help Ghana supposed to do it - should he die to prove his loyalty?
