Health Essentials
Glaucoma – a call to have your eyes checked
As we raise awareness of Glaucoma this week (it should continue all year), the importance of community education to prevent vision loss, regular eye care and early detection of this silent disease is key. The theme “SEE THE FUTURE CLEARLY” puts the whole process into perspective.
What will you do if after years of enjoying the beauty of the world through your eyes, you wake up one day and realize your eyes are failing or have failed you? It could be a major life-changing event. You may even run the risk of causing accidents. Imagine what one goes through during the DUM phase of DUMSOR.
Now imagine life perpetually in DUM. All this could be prevented if you make time to care for your eyes: check your eye pressure and have your sight checked as well.
Glaucoma is a group of eye conditions that damage the optic nerve (nerve of the eye) leading to loss of vision. It is most often but not always associated with an increase in eye pressure.
In Ghana, glaucoma is a leading cause of blindness second only to cataract. Ghana appears to have many challenges with “vision” (note the pun) as we have been identified as the country with the second (some data quote third) highest prevalence rate of glaucoma.
Glaucoma is sometimes referred to as the “silent thief of sight” because it can damage your vision so gradually that you may not notice any loss of vision until the disease is at an advanced stage. The most common type of glaucoma, primary open-angle glaucoma has no noticeable signs or symptoms except gradual vision loss. As always, the key is to be diagnosed early and managed since this can prevent or minimize damage to the optic nerve. Early diagnosis is only possible if we have regular check-ups. I checked my eye-pressures six months ago, what about you?
Isolating the risk factors
1. Age – Anyone can get glaucoma, but it most often occurs in those above forty years.
2. Ethnicity – Africans and African Americans are at an increased risk compared to Caucasians. In high-risk groups it may be necessary to have your eyes checked even in your 20s.
3. Family History/ Genetics – You are at an increased risk if a member of your family has glaucoma.
4. Medical Conditions – Diabetics and people with hypothyroidism are also prone
5. Nearsighted/shortsighted – For this group of people, objects in the distance appear fuzzy without corrective lenses.
6. Prolonged Steroid use – especially if used as eye drops, increases our risk for glaucoma.
7. Other Eye conditions – Severe eye injury, some of which may even cause the eye lens to dislocate. Retinal detachment, eye tumours and some eye infections may also predispose us. Some eye surgeries may occasionally trigger glaucoma.
Recognising the warning signs
It is important to drum home the point that just as in high blood pressure, there may be no warning signs. As stated above, the commonest form of glaucoma will hardly warn you. In some forms of glaucoma, however, we may experience the following:
1. Gradual loss of peripheral (side) vision leading to tunnel vision where one is able to see only objects directly in front of him/her
2. Redness of the eye
3. Blurred vision
4. Halos around lights
5. Severe eye pain is sometimes associated with nausea and vomiting
6. Sudden onset of poor vision especially in low light
Overview of tests available
1. Measuring eye pressure. This is a simple painless procedure. It is often the first line for screening for people with glaucoma.
2. Visual Field Test – your doctor will use this test to determine whether glaucoma has affected your peripheral vision
3. Several other tests are available and include testing for optic nerve damage and measuring corneal thickness.
Treatment options
There is NO CURE for glaucoma, but it can be successfully managed. Our options include eye drops, oral medication or surgery, which reduce pressure in the eye to a level that is unlikely to cause further optic nerve damage.
You may not be able to prevent glaucoma, but you can avoid its complications if diagnosed and its management started early. Talk to your healthcare professional and have eye examinations when necessary.
This is the only way to ensure that you can “…see clearly now the rain is gone. I can see all obstacles in my way” and you will enjoy this great vision for years to come.
Glaucoma is “a silent thief of sight.” This is another reminder that NOT ALL SILENCE IS GOLDEN! Get checked.
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)
(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.”
References:
1. 37 Military Hospital Eye Department infomercials
2. Mosby’s ACE the BOARDS
3. www.mayoclinic.com
By Dr. Kojo Cobba Essel
The call to action
We must move beyond the cycle of temporary outrage. I propose a four-point blueprint for the Ministry of Health and the government:
1. A Digital Bed-Tracking Command Centre: Legally mandate all public and major private hospitals to update a live, digital bed-registry every hour. The NAS must be able to see a vacancy before they move. This must be matched with the available resources and services so that the right patient will be sent to the right facility.
2. Strategic Capacity Expansion: We must stop building “prestige projects” and start building high-volume stabilisation centres. We need a targeted investment to triple the ER bed count in Accra and Kumasi within 24 months. This should then be extended to other regional capitals.
3. Specialised Emergency Hubs: Designate specific hospitals as “Centres of Excellence” for Cardiac and Stroke care (and for other health emergencies), ensuring they have 24/7 imaging and intervention capabilities as well as the requisite expertise to manage these conditions. Policy makers must incentivise public-private partnerships to ensure that a heart attack in Accra or Kumasi can be treated with the same urgency as one in New York.
4. Develop a nationwide trauma system: This is extremely important because trauma is a major cause of deaths in Ghana. In the US, each state has a statewide trauma system with three levels. Level 1 trauma centres are usually University Teaching hospitals that provide comprehensive trauma care and also play an important role in local trauma system development, regional disaster planning, increasing capacity and advancing trauma care through research. Level II trauma centres are expected to provide initial definitive trauma care for a wide range of injuries and injury severity.
Level III centres provide definitive care to patients with mild trauma. Having such systems is imperative to ensure proper treatment of trauma patients.
Even for those who survive trauma, disability is a major assault on economic potential and viability. Importantly all this cannot happen with a cash and carry system. Emergencies should be managed under a different model to save life and limb first. Obviously, there is a need to ensure that healthcare facilities will be able to recover their investments in emergency care, and that balancing act needs careful consideration.
Frontline clinicians are often forced to bear the public’s anger for infrastructure deficits they did not create and cannot fix. This is a failure of governance, not a lack of clinical care. Responsibility lies with the policy makers who manage the nation’s resources.
The “No Bed Syndrome” is a systemic disease. It cannot be cured with a directive from the Ministry of Health, parliament or a lecture on ethics. It requires a blueprint, a budget, and the political will to treat this like the menacing threat it is.
It is safe to say that non-emergent healthcare is excellent in Ghana for the most part if you can afford it. However, emergency care is suboptimal. We had a sitting president die from an emergency health issue and a former vice president also die from an emergency. If that is not enough warning, it is clear that anyone can be a victim of an emergency.
If we do not act, the next ambulance driving aimlessly through the streets of Accra could be carrying anyone, including the very people who have the power to fix this issue.
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 Clinic Informatics.
He is a graduate of the University of Ghana Medical School (Class of 1997)
Health Essentials
Why Ghana’s ‘no bed syndrome’ is a policy failure, not a clinical failure – Part one
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).
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