No Bed Syndrome- Who Cares for the Caregivers

By: Dr Anthony Ofosu- Deputy Director Ghana Health Service | www.facebook.com/AceAnanAnkomah

In our lives, we make a lot of assumptions, some based on experience and some based on just good faith. I have over the years operated on the assumption that, serving your country is like serving your parents; I served my parents with obedience as a child and my parents on their part, have been good to me. Based on a similar assumption, I expect my country to also be good to me, once I put in my service. Unfortunately, I have come to a sad realisation that this assumption is seriously flawed. I have been too idealistic. In my career as a doctor, I have tried to uphold the oath I took as a doctor. I have been against all doctors strikes and have condemned what I thought was uncaring attitude of some of my colleagues. I have on numerous occasions spoken out against health workers moonlighting. I even have questioned their integrity because I believed they were placing money above vocation. I have however come to realise that my country only has use for you when you are strong and on your feet, the moment you are in no position to serve as you used to, you will be discarded. I may be wrong again in this new assumption, but this assumption is now based on my own personal experience that I will subsequently recount.

I have spent twenty-four years of my life in service in the Health Sector. I can say and without any reservation that I have paid my dues to my country. I completed medical school at the peak of the brain drain, when doctors were migrating daily to the United Kingdom and the United States on my part, I went voluntarily to the Brong-Ahafo (BA) Region; No one posted me there! I worked in BA for sixteen years. During those 16 years, I worked in Sene District– a district where the majority of health workers had refused to work in. For six years, I was the only doctor in Sene District serving a population of 120,000. I set up from scratch the district hospital in Sene district and later established peripheral facilities to improve access to health services. I was the first doctor to set up a surgical suite and start surgeries. I sometimes did surgeries throughout the night, sometimes using a torchlight when the light goes off. No matter how busy my night, I saw it as my duty, my commitment to my country, to go to the outpatient department the next morning to attend to patients. I have worked at the senior management level of the Health Sector as a District Director, Medical Superintendent and Deputy Director since 1995. On the fateful night of 23rd December 2016 as I lay unconscious on a stretcher in front of the Korle-bu emergency room, all thes, counted for nothing. There was simply no bed for me.

The Health Sector I had laboured for with the strength of my youthful years, and continue to serve until this night, told my wife that there was no bed in the emergency room for me. To even make matters worse, I was being ejected from the stretcher that my family had put me on, as according to the staff, it belonged to the female emergency room. I laid unattended on this stretcher for close to twenty minutes, my wife in desperation called a colleague working in Korle-bu, and who was fortunately able to arrange and get me to the ward where I was promptly attended. The question I have been asking myself is – Does one need to be acquainted with or know someone in a health facility before being given life-saving emergency attention and care? I give thanks to God that I survived; but something within me died that night. What happened to me should not happen to any Ghanaian. Where is the blame? We as managers of the health system have created a system that is not responsive to the needs of the population, and has no means of treating its own any better. A lot of our own, doctors and nurses have died unattended lying on stretchers or in the corridors of the Korle-bu emergency room. This should not happen to anyone but more especially it should not happen to a health worker. As the adage in Akan goes “Obia dede nagyuma hu”. To wit ‘everyone eats from his work place.” Unfortunately for us in the health sector, this adage does not hold true.

The Ghana Health Service motto says to the general public “Your Health, Our Concern,” – unfortunately; the health of the worker is not the concern of the Ghana Health Service. As a staff of the Ghana Health Service if you are not registered with the National Health Insurance you pay all your hospital bills out of pocket. The only free service that you will get is that if you are not able to pay your medical bills and you die, the service will waive two weeks of your mortuary fees for your family.

It is very unfortunate that although a lot of workers outside the health sector have health insurance cover for themselves, their spouses and their children, medical professionals in public service have to pay out-of-pocket to receive health care. I know a colleague of mine, a medical doctor who together with his children are covered by the wife’s workplace medical insurance.

My journey onto that fateful day, 23rd December 2016, began with an elective surgery in the previous month, November 2016. I had paid out of pocket for the surgery, although I am a registered National Health Insurance holder and active. The procedure I underwent is not covered under the benefit package of the NHIS. The Ghana Health Service, my employer, one that I have laboured for, for twenty-four years of my life, has no staff medical insurance. With all my years of dedicated service, not a farthing was spent on my medical bills by the Ghana Health Service. It is worth mentioning however, that the skills and competence of the surgeons who performed my surgery was exceptional. I was very impressed with all the safety routines that were instituted in the theatre. Nothing was left to chance. They performed their duties with the highest level of competence using the available resources at their disposal. The Ghana College of Physicians and Surgeons has been training and certifying all specialists over the years since its establishment and have done a great job! While on admission, I came to understand why it has not been impossible to get senior doctors to be on duty in the emergency rooms of the Korle-bu teaching hospital; and why house officers are made attend to referrals made from District and Regional Hospitals doctors who by far seniors in the profession.

This highly skilled health work force is being compelled to work in a very dysfunctional system, which stirs up a lot of frustration in their daily bid to practice at the zenith of their skills. With skills that are in high demand but not appreciated by the primary employer, they find alternate and additional ways of practicing the skills they know best, while making some extra money to sustain a decent standard of living for their families. They are confronted daily with the reality that should they fall ill in the line of duty, they are on their own. So, they have learnt create their own social security. These are some of the reasons for the moonlighting that is so prevalent among health workers in the public sector.
Should we continue to fail to find both immediate mitigating and long-term solutions, where in the odd hours of the night, in Korle-bu hospital, there are no beds or no senior doctors to attend to patients, every Ghanaian is at risk. Not leaving out policy-makers or politicians who jet-off to South Africa, India or Germany when they have a medical problem. They may not be so lucky when they get an emergency situation that will demand being sent immediately to a hospital. It is in everyone’s interest that we fix this no bed syndrome as quickly as we can and ensure that basic emergency care are made available to all the citizens of this country. Till we do this, we are all at risk, including those who feel they have no need of our health system

For me personally, on that fateful night of 23rd December 2017, I died to sacrifice and I came to the realization that the Health Sector has use for you as a health worker when you are healthy and slaving away, but once you fall sick and become incapacitated, you are on your own. I am now learning to be on my own, and just do the little that will let me sleep well at night with a clear conscience knowing that I have earned my keep.

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