Health Essentials
‘One man’s meat…’
The first time I saw someone eat dog meat I was scandalised. I did not understand how that could happen, but it did. And I saw it. We went for a sports festival in one of the towns in the Volta Region in 1964 and food vendors were around selling their stuff. An aroma of barbecue wafted through the air that drew school children to the fire.
A soldier in uniform picked a stick of the khebab, paid for it and sauntered away to enjoy the meat. Just a few moments later, he turned back to the vendor and asked why he sold him dog meat. I wondered how he knew it was dog meat, but it turned out he had eaten it before and knew that taste. I do not want to narrate what happened to the poor guy who sold the meat.
As time went on I found myself eating python meat that same year. This reptile slithered into the thatched roof of a neighbour when its hole was inundated with flood waters of the Keta Lagoon. The big boys in the area caught it, skinned it and we made a meal of the meat. It tasted like chicken, except it had too much fat. I did enjoy it though.
Some cousins and I used to go set traps at a cemetery a mile out of town during weekends to catch rats, which we cooked and feasted on. To us it was to take our minds off the drudgery of academic and house chores all week; an adventure, if you may call it so. We caught and ate doves, water fowls, quails and hawks. Seasonally, we ate migratory birds like gulls and pelicans. Some of these birds had metal rings with inscriptions on their legs. We were after the meat, not the rings.
I could have eaten meat from a monitor lizard if it was not the totem of the Like Clan I belong to. I am told the Like do not eat this reptile and sawfish. Story has it that a great Like ancestor was saved from drowning by a sawfish, thus our prohibition from eating its meat.
Until I became a vegetarian in 1974, I had eaten meat from cat, rabbit, bat, crocodile and tortoise. I recollect a seminar I attended in Kampala, Uganda, in the late 80s. A Ugandan participant invited some of us to his house. As we entered the compound I saw scores of grasscutters scuttling all over and some ran to him as dogs do their masters. In amazement, I asked, “Mr. Okot, what are you doing with these rodents in your home?” He said they were his pets.
When I told him it was the most expensive meat in Ghana, he took a step back from me as if I had landed from another planet. Apparently, East Africans do not eat grasscutter, period!
Only last week, there was this hoopla on the international news channels for a whole day about Kurt Zouma, a former Chelsea defender, now playing for West Ham, molesting a cat in his home. Suggestions were thrown about to the effect that he needed counseling. Of course, cruelty to any animal is against the law in many countries, including England where he plays his football.
I observe the way we treat our domestic animals and it is abhorrent, to say the least. But the question that came to my mind was what would have happened if Kurt Zouma had mercifully killed that cat and feasted on its meat, were he Ewe from Ghana, Togo or Benin? The Crown Court would have handed him a jail term by now. My father had a way of slaughtering a cat the way we do either a goat or chicken, not the way people strangulate the poor feline or drown it in a sack or any other means. Of course, there are many ways to kill a cat, not so?
Back home in Ghana, one group’s delicacy is another’s taboo. There are others who eat anything that has life; anything that moves, actually. There must be varying reasons a certain group of people will not eat certain things. This might be steeped in religion, spirituality or even superstition or myth. Whatever the case, animals must be treated with respect even if we rear them for consumption.
There is this rodent in En-Gedi in Israel. It’s a cross between the rat and the grasscutter. They are so plenty and notoriously destructive to the sparse vegetation in that desert area that the Israeli government does not know how to exterminate them. Unfortunately, because of my commitment not to eat any flesh, let alone take life, there is practically nothing I can do to help Israel. If not, I would set up camp at En-Gedi, trap these rodents and smoke them the way we do bush meat in our parts and ship them in neat packages to Ghana. The boxes would be labelled, “Smoked Meat of the Holy Land of Israel.” You can bet the churches will do the marketing for me.
I sympathise with Kurt Zouma. Africans generally do not respect animals as having the feeling of happiness and pain. We kick and beat our pets at will. It is in our DNA, which is no excuse for cruelty towards them. I watch documentaries on television where people pay thousands of dollars in veterinary bills for their pets like dogs, cats, pigs, birds of all kinds and even reptiles.
Tibetans are a pious, very spiritual Buddhists who are mostly vegetarians. When China invaded this mountain region in the early 50s they ate all their cats and dogs and every other living things that moved. In the Congo area of Africa every living creature there is edible. Insects of all kinds, some roaches, grubs, worms of all types are on the menu.
I once took a friend out for lunch in one restaurant in Accra. When she heard an order from the adjoining table for frog legs, she vowed never to eat in that restaurant any longer. This is largely because in our minds certain things are unimaginable. I recall the renown pathologist, Prof. Agyeman Badu Akosa, said in an interview on national television on the issue of vultures being served as meat that, “It’s just muscle, that’s all.”
Animal rights activists have taken their fights quite well, especially on the poaching of certain species in the wild to near extinction. Rhino, tiger, leopard parts considered medicinal are a million-dollar business in the Far East. In our parts chameleons, parrots, fork-tailed lizards and the left hand of green monkeys are prized commodities.
The understanding and/or otherwise of nature’s balance and the ecosystem brews the ideal ingredient of conflict. Education is needed for the right approach to issues bordering on protecting the species so that as we consume these animals, the scale of the ecosystem is not tilted towards the destruction of the very things that give us life. When “the last tree dies, the last man dies” is the adage, but we forget that animals propagate the seeds of the plants that constitute our forests and give shelter to our wildlife.
By Dr. Akofa K. Segbefia
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).
