Health Essentials
Why Ghana’s ‘no bed syndrome’ is a policy failure, not a clinical failure – Part one
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OVER the years, No Bed Syndrome has been a major headache in Ghana’s health system. People have expressed different views and today my friend and classmate Professor Jonathan Laryea takes his turn and makes extremely important contributions that should start a deep conversation.
Professor Laryea writes;
Every few months, Ghana wakes up to a familiar, tragic headline. A prominent citizen, a pregnant mother, or a young accident victim has died in the back of an ambulance. They didn’t die because medical science failed them; they died because they spent their “Golden Hour”, the critical window between life and death, touring the gates of hospitals that had no room to receive them.
The public outcry follows a predictable script: anger at the hospitals, calls for “compassion” from doctors and nurses, and a frantic directive from the minister of health and parliament. A few years ago, the directive was simple: No hospital can turn a patient away. The result? We didn’t create more beds; we simply moved the crisis from the ambulance floor to the hospital floor. That also created another outrage.
It is time to stop blaming the frontline workers and start looking at the math. The “No Bed Syndrome” is not a failure of healthcare workers; it is a failure of a country that has not matched its resources to its population growth. Most recently, an engineer lost his life after being involved in an accident. The ambulance drove around for hours before getting to Korle Bu. Though the outcome was sad, I would venture to say that even if Korle Bu had a bed to treat this patient, the outcome would likely have been the same given the time between the accident and when the ambulance got to Korle Bu. When you have a patient exsanguinating, time is of the essence. Even if he got to the right place in time, the other question is would they have enough blood to resuscitate him without requiring family to donate prior to administering the blood?
The impossible equation
Consider the capital city. Accra has a population of approximately 2.9 – 4 million people, depending on who you ask. To serve this massive, high-density population, there are fewer than 400 dedicated emergency room beds across major public facilities.
Let’s do the math: that is roughly one emergency bed for every 10,000 citizens. That is not a recipe for success. When a system is constantly operating at 110 per cent capacity, “No Bed” isn’t an excuse, it is a physical reality. When we force doctors and nurses to treat patients on the floor, we aren’t “solving” the problem; we are compromising hygiene, dignity, and clinical outcomes. You cannot perform a high-quality resuscitation on a crowded floor. This is a capacity issue. We cannot expect this issue to fix itself. There is the need to increase emergency capacity across the metropolis and indeed across the country.
A system in need of coordination
The second failure is logistical. Ghana has made strides in developing a National Ambulance Service (NAS), but we have failed to give that service a “brain” to coordinate it. Currently, an ambulance driver picks up a patient and begins a desperate, manual search for a vacancy. They drive from Ridge Hospital to 37 Military Hospital to Korle-Bu, burning through the patient’s oxygen and time. In an era of digital transformation, it is inexcusable that our ambulances do not have a real-time, cloud-based dashboard showing exactly where the nearest available specialised bed is located. An ambulance without a coordinated dispatch system is just a high-speed hearse.
Beyond the furniture: The “emergency mindset”
A bed, however, is just a piece of furniture if it is not backed by an emergency pathway. The true “No Bed Syndrome” includes a lack of specialised systems. In modern medicine, the “Golden Hour” dictates that, for example:
• For a heart attack: We must be able to perform cardiac catheterization within 60 to 90 minutes.
• For a stroke: We must have the ability to perform a CT scan and administer clot-busting medication within an hour.
In Ghana, if you have a stroke or heart attack, your survival depends more on your luck and your traffic route than on a standardised medical protocol. If a patient reaches a bed but the CT scanner is broken or there is no Cardiac Catheterisation Laboratory or the Catheterisation laboratory is unstaffed/unresourced, the “syndrome” has simply moved from the ambulance to the ward. We have failed to develop the specialized “hubs” required to treat these time-sensitive killers. Accident cases are even worse. The ability to give blood emergently to exsanguinating patients does not exist. Some patients need immediate surgery; for example, patients with gunshot wounds and stab wounds. Sending such patients to a facility where they cannot do emergency surgery is unhelpful.
We must develop a system for triaging patients to the right facilities. There is a need to do a thorough evaluation of our healthcare delivery system and redesign a system that works for Ghanaians. It looks like we have done a patchwork of modifications to what Governor Guggisberg left us and after 69 years of self-governance, we have failed to redesign a system that works for modern-day realities.
Prof. Jonathan Laryea is a Professor of Surgery at the University of Arkansas for Medical Sciences in Little Rock, Arkansas. He is board certified in General Surgery, Colorectal Surgery and Clinical Informatics.
He is a graduate of the University of Ghana Medical School (Class of 1997).
I have over the past two decades looked beyond mainstream medicine to assess other options that lead to holistic health, and I must say it’s been exciting and revealing but it’s not an easy path.
As I matured and my knowledge expanded, I have changed my opinion on some aspects of wellness and many findings have been humbling. We all continue to learn each day.
I will share some of the life-changing skills that we take for granted. In our quest for wellness there appears to be more questions than answers, but moderation still remains key in our daily lives.
The power of prayer, praise and worship of God cannot be taken out of the equation.
Ready. Set. Let us do this together.
- Strength training is a must for ALL of us
- Yes, we all need to dig into the various aspects of exercise; strength training, cardiovascular training, stretches or flexibility training and balance training. If you asked me about a decade ago to pick the king of all exercises, I would naively have answered cardiovascular such as walking, cycling etc. but I am certain now that strength training trumps all and we need to incorporate at least a bit of that in our exercise programme.
- Take a short walk after each meal
- Many of us (your truly included) after dinner barely get to wash our hands before the miracle of the Lotus Eaters sends us to dreamland. Our fingers will be signaling to rats and cockroaches to come out and party.
- Walking a few minutes after eating may hold the key to helping control our blood sugar levels and reduce the spikes in insulin that come with a myriad of issues. At the very least the short walks after eating will add up to increase the energy you expend daily.
- Eating your vegetables and proteins before your carbohydrates may be helpful
- Well, how true may this be? I suggest it is worth trying. I am not saying clear your plate of all protein before you even take a spoonful of carbohydrate. The fibre will slow the absorption of the sugar for hours and even better, you may feel full after the vegetables and protein and not be able to gobble down the mounds of carbohydrates you had planned to dismantle.
- Eat slowly but do not get your boss angry
- Eating slowly does not mean spending hours at lunch and courting the displeasure of your superiors. It takes about 20 minutes for your brain to realise you are full so dear friend, take your time to chew and enjoy your food. A meal “downed” in less than 20 minutes may cause you to virtually suffocate when you top up with water. This is a message to myself and all those who like me eat so quickly that Usain Bolt will envy our speed.
- Eat from small, colourful plates
- Small colourful plates make an impression on our brains. Since the little food appears loaded on a small plate our brains tend to “believe” it’s a lot of food and we feel full for a strange reason. Put the same amount in a large plate and you are likely to be asking for second servings.
- By all means make friends
- The power of social wellness and its role in longevity and an enviable health span is no longer in doubt. By all means make a few good friends and enjoy life! Thank me later.
- Sleep!
- Yes, I do agree there are at least seven forms of rest, and they are all equally important BUT start off with sleep and we will gradually rope in all others.
- Keep your eyes on your numbers
- I have written and spoken about the miracle of knowing our numbers and keeping them in check; blood pressure, blood sugar, lipids and BMI. Today I suggest you look at your heart rate closely. A low heart rate may be an indicator for staying here on planet earth for a long time. Also keeping glycated haemoglobin (long term blood sugar) low is another feather in the cap of longevity.
- Appropriate supplementation
- The golden rule is to get all your nutrients from your food but for many of us that may not be possible hence the need to supplement ( note that supplement overdose does exist)
- It is ideal to discuss supplementation with your healthcare professional and your discussion should look at probiotics, magnesium glycinate, Vit D3 + K2, a good multivitamin and in some instances creatine or whey Protein. I am in no way suggesting you take all these, each individual is unique and that is why it is crucial to discuss your options with a professional.
- Make a conscious effort to be HAPPY
- Happiness affects our entire being in positive ways; smile, say a kind word to someone, be grateful, surround yourself with people who make you happy and not ones who sap your energy, volunteer to support people and by all means get a hobby eg gardening, playing a game etc and the best get news yet; you don’t even have to be good at your hobby to benefit.
We are not waiting for a magical or ideal day to start working on our Health and Wellness, we start today bearing in mind that “the most efficient way to reach our realistic health and wellness goals is to make small healthy choices daily.
AS ALWAYS LAUGH OFTEN, ENSURE HYGIENE, WALK AND PRAY EVERYDAY AND REMEMBER IT’S A PRICELESS GIFT TO KNOW YOUR NUMBERS (blood sugar, blood pressure, blood cholesterol, BMI)
Dr. Kojo Cobba Essel
Health Essentials Ltd/ Medics Clinic
(dressel@healthessentialsgh.com)
*Dr. Essel is a Medical Doctor with a keen interest in Lifestyle Medicine, He holds an MBA and is an ISSA Specialist in Exercise Therapy, Fitness Nutrition and Corrective Exercise. He is the author of the award-winning book, ‘Unravelling The Essentials of Health & Wealth.’
Thought for the week – “WHERE YOU LIVE SHOULD NOT DETERMINE IF YOU LIVE.”- WHO
Very often we leave the doctor’s office only to remember that we left out a major complaint. Some patients immediately rush back to the consulting room totally oblivious of the privacy that the next patient is entitled to.
They expect that as they walk in, the doctor should ignore the seated or positioned patient and attend to them. That is totally outrageous. Others go home and continue to live with the condition hoping to be healed miraculously.
Most of us will be extremely lucky to spend 15 minutes with our doctor and this time is often much shorter in countries/communities where the doctor-patient ratio is so low that at best it can be described as criminal.
We are now in the second half of 2026, and I highly recommend that you see a doctor not only when you are unwell but as a means to assess your state of wellbeing and take the needed precautions. It is critical that you find a good primary care doctor who is knowledgeable and proactive and will also be able to coordinate specialist care that you may require.
To make the most out of our time with the doctor we need to PREPARE. If your condition is an emergency, then you do not have the benefit of time to prepare.
A must do!
Kindly ensure your personal hygiene is excellent.
- Take a good bath and brush your teeth
- Wear clean clothes that also make undressing easy, especially if you need to expose some areas for inspection/examination.
This may sound ridiculous, but the opposite does happen in real life.
Remember that doctors are human and when you are unkempt you may not get adequate contact with your doctor.
Research on the symptoms
If you have access to the internet or a book worth its salt you may read about your symptoms or wait to read after your doctor tells you your diagnosis.
Remember that if you need to research on the internet, it is essential that you use a reputable site.
In tune with your complaints
- Write down your complaints/symptoms if you think you may forget.
- If you have had a similar problem and have the results of any investigations e.g. Laboratory tests, x-rays, CT scans etc kindly carry them along
- Let your doctor know if you react to any drugs.
- Be truthful about any medications you have taken for the condition, if you do not remember the names make sure you go with the containers.
- If you have any other medical conditions (and medication) make the doctor aware.
- Remember to make a note of the following
- When did the symptoms/complaint begin?
- How long have you had these symptoms?
- Is it getting worse?
- Does anything make the condition worse?
- What makes you feel better?
- Is anything related to their onset?
- How often does it occur?
- How long does it last e.g. in pain conditions as well as rash, allergies etc.
- Does anyone else in your family have them?
- How do they affect your daily life?
- Is it related to work or home?
You may need to modify these slightly when you have skin lesions, swellings etc. This list is by no means exhaustive, and you may not need to find answers to all of them before getting help, but they will definitely help you ace the visit to your doctor.
If your doctor books you for surgery, do not leave his presence without finding out the following:
- Will you go home on the same day of the surgery?
- Will you need assistance to go home or can you drive unsupervised for instance
- What form of anaesthesia will you be given?
Then, if your visit is for a medical examination, do remember that also being aware of disease conditions in your family will help your doctor select the appropriate tests and make the whole experience and time useful.
Finally do not leave your doctor without finding out:
- How much physical activity/exercise you require; the Almighty “FITT” prescription
- What you need to eat or avoid.
- Some basic information regarding SLEEP.
See you in the consulting room soon.
AS ALWAYS LAUGH OFTEN, ENSURE HYGIENE, WALK AND PRAY EVERYDAY AND REMEMBER IT’S A PRICELESS GIFT TO KNOW YOUR NUMBERS (blood sugar, blood pressure, blood cholesterol, BMI)
Dr. Kojo Cobba Essel
Health Essentials Ltd (HE&W Group)/Medics Clinic
(dressel@healthessentialsgh.com)
*Dr. Essel is a Medical Doctor with a keen interest in Lifestyle Medicine, He holds an MBA and is an ISSA Specialist in Exercise Therapy, Fitness Nutrition and Corrective Exercise. He is the author of the award-winning book, ‘Unravelling The Essentials of Health & Wealth.’
Thought for the week – “The next big thing in Healthcare in Ghana is the Medics Clinic. Visit https://medicsgroupgh.com/ for more information.”
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