analysisBy Arthur Kobina Kennedy
There is a major crisis brewing in our hospitals. This crisis involves equipment, infrastructure and personnel. Let me focus just on equipment today.
The "Ghanaian Times" reported on Tuesday, May 17th 2011 on the state of equipment at our nation's premier hospital, Korle-Bu Teaching hospital. According to the newspaper, "Most of the machines at the Radiology
Department of KBTH have either broken down or are in a poor state."
The report said the CT scanner at the hospital has not been working for the last two weeks. The paper continued, "Speaking to the TIMES about the situation on Friday, Mr. Steven Boateng, Chief Radiographer, revealed that most of the machines used at the Department have broken down while the few functional ones had become obsolete. He said the machines were over 19 years old, hence their frequent breakdowns." Elsewhere, he added that 'the situation was getting worse and we are compelled to turn patients away who need to access the CT machine due to constant breakdowns."
Elsewhere, he added patients are charged GH 140 per scan and the hospital can schedule thirty patients per day.
The shortages reveled at Korle-Bu are typical of our hospitals. To complete the picture, there is no CT Scanner West of Accra or north of Kumasi. To appreciate how significant this is, let us review what a CT scanner does. It is a machine that takes sliced images of the body and puts them together for the Doctor to see what may be going on inside the body.
For instance, when someone has a stroke, characterized sometimes by distortion of the face, weakness of parts of the body and difficulty in speaking, it is recommended that they have a CT Scan of the Brain (Head) done within an hour so that Doctors can determine whether the stroke is due to a blockage of blood vessels in the brain or bleeding into the brain.
When it can clearly be determined that the stroke is due to blockage, medications can be given to dissolve the clot. Sometimes, when this is done very successfully, the patient can be restored to virtually normal function. Without the information obtained from the CT scan, the care provided by the Doctor is inadequate.
CT Scanners are also useful in the investigation of many other diseases, including injuries as well as cancers and many other illnesses. I shall return to CT Scanners in a moment but there is a bigger story.
The implication of the absence of CT Scanners West of Accra and North of Kumasi is that if one unfortunately gets a stroke, say in Cape Coast or Enchi or Tamale, their chances of receiving timely, state of the art care is significantly reduced. Even in optimal circumstances, it would take hours for such a patient to reach the nearest CT scanner!
Unfortunately, In addition to high priced equipment, like CT Scanners, MRI's, Dialysis machines etc that are in short supply, the truth is that much more basic equipment are shockingly unavailable. Some of these are Pulse Oximeters, Peak Flow meters and Electrocardiograms. I write this from first-hand experience. There are no Pulse Oximeters on the Medicine Wards or at the Accident and Emergency Center at the Central Regional hospital where I work.
This lack, it appears, is not isolated. Indeed, I reported on these shortages in a survey that I conducted for the Ministry of Health and Ghana Health Service in 2008. These shortages and deficiencies are the frequent subjects of complaints by Nurses and Doctors.
To make matters worse, in corroboration of Mr. Boateng's comments, even where equipment exists, maintenance is woefully inadequate.
The result is that the equipment, which is inadequate to begin with, does not operate as expected most of the time. This means that tests that normally should be completed in a day take days to complete. This obviously impacts patient care negatively.
I have discussed this situation with many other Doctors who like me, feel distressed about this situation.
At some point, it is difficult to believe that we are helping our patients when so many who could better continue to stay sick or sometimes, die because of these difficulties.
My fellow Ghanaians, it should not be acceptable for our hospitals to be in the state they are in.
There should be non-partisan outrage against this kind of collective negligence that we are inflicting on our country day-in, day-out.
Diseases do not discriminate between people on party lines. Death comes to all regardless of party. No party label inures one to pain. Sooner or later, even those who have money to get care abroad will find that in some sicknesses, time is more of essence than money.
Therefore, we must act.
Indeed, it appears that all across our healthcare system, in the area of equipment, we are being pennywise and pound foolish.
When needless delays in getting simple tests prolong the stay of patients in the hospitals, it increases costs for our hospitals. Let me give an example.
If a patient is admitted and the Doctor orders a test that will help guide treatment on the first day but does not get the results for three days--the patient is kept in the hospital for an extra day or two because of the delays in obtaining results.
Each extra day in hospital requires nursing and other staff time. That extra care is needless, expensive and indeed may expose the patient to risks of other illness--like malaria while in the hospital.
Honestly, I do not even know how one can begin to tackle these problems. Every Doctor or nurse I have encountered is concerned about this issue.
Every hospital administrator I have spoken to is concerned about this issue.
Every person whose care is compromised is concerned about this.
First, let me commend the 'GHANAIAN TIMES" for this important story. I urge them and other media to follow this up with stories about shortages in other hospitals and to follow these reports with editorials calling for action to fix these problems.
They should let the reporting on politics just for the sake of politics take a break for a while. We can do fine with a little more focus on problems and a little less focus on politics.
Second, to return to Korle-Bu where it all started, if they have been charging 140 Ghana cedis per scan and doing thirty scans per day, presumably for years, why have they not bought another scan? It would appear that we should, particularly since there is re-imbursement from the NHIS, see more hospitals take the initiative to acquire or replace needed equipment. This can be helped by prudent partnerships with private financial and other institutions.
Third, the Ghana Health Service is responsible for running all Government hospitals with the exception of the Teaching Hospitals. Is the Service not aware of the equipment deficits highlighted by the "GHANAIAN TIMES" and chronicled here? Do they have lists of equipment required by hospitals based on their classification? Do they periodically match this with inventories of what the hospitals have?
How many of our hospitals have the needed equipment? Can we truly say that we cannot afford Pulse Oximeters and Peak Flow meters for our hospitals? Indeed, every health post must have this basic equipment.
Ghana Health Service
While the Ghana Health Service is dealing with these issues, there are challenges that must be met at the level of government.
As a compassionate country that believes in being each our brother's keeper, how can we have a health insurance system that requires the person with a stroke to find money for a CT scan? How can we require the man with Chest pain to find money for an EKG? There are things that we should provide for those who have insurance.
Indeed, along the lines of providing free maternal care to those pregnant, and free care to HIV patients, we should provide CT Scans and EKG's for those who might be having strokes or heart attacks free of charge.
It is obvious that while the NHIS was a visionary policy that has saved a lot of lives, it needs to be revamped. In addition to making sure that it covers obvious tests like CT Scans, Electrocardiograms and Glycosylated hemoglobin, there needs to be enabling investments in our hospitals.
These investments should go into expansion of existing hospitals, the building of new ones, the provision or upgrading of equipment and increases in all staff to match the increased demand brought by the introduction of the NHIS.
Even while looking at how to tackle these issues in the long-term, we must have an emergency plan to provide our hospitals with the needed basic equipment--like Pulse Oximeters, EKG machines and Peak flow meters everywhere, together with CT Scanners in Tamale, Cape Coast and Takoradi for a start.
Let us work together, to make Ghana a healthier, more compassionate nation.
Arthur Kobina Kennedy MD, is from the University of Cape Coast, Cape Coast