Features
Why Ghana’s ‘no bed syndrome’ is a policy failure, not a clinical failure -Part 2
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)
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THE typical itinerant salesman in Sikaman is a herbalist. He is normally a slim macho with the capacity to perambulate the expanse of area covering the triangle of Accra-Tema-Ashiaman. In short, he can walk a total of 60 miles a day, marketing a product that cures every disease, including poverty. 
The door-to-door herbal pharmacist advertises his product by word of mouth. He has nothing to do with the Food and Drugs Board (FDB). After all, his concoctions do not feature on FM stations.
Those herbalists who cannot walk to propagate the herbal gospel, liaise with drivers of mass transportation and their mates. They are, therefore, given the chance to sell their products on Benz buses that ply the routes.
Normally, the herbalist starts his sales message with a prayer and Bible study. He asks the passengers to bow down their heads in supplication to God the father, the son, the Holy Spirit.
When a herbalist asks the passengers to close their eyes and bow their heads, Moslems on board naturally feel offended. They feel that the herbalist has no right to assume that every passenger is a Christian. They think such an assumption is an affront to Islam.
So a Moslem on board will raise the hand for a point of order. He’ll remind the herbalist that it would be in his own interest to mind his language.
“Be careful the way you address people in a public place. Not every person here is a Christian,” he’d state assertively.
Of course, the herbalist will promptly ignore him, but would all the same “watch” his tongue. Who knows whether or not the Moslem brother is inspired by Quoranic zeal to defend the tenets of Islam to the hilt?
When he starts saying, “Wallahi!” and “Inshallah!” it could be the beginning of proclaiming Islam as supreme, a point which must be driven home with talibanic precision.
So the herbalist must tread carefully lest he steps on fire.
The herbalist could even add a measure of mirth to it all, by announcing that Christians on board today have very interesting company on the journey, but that should not detract from the business of the day.
The Moslem brother will weigh the words carefully and offer a wry smile.
He must be careful the occasion does not degenerate into the use of semantics and proverbial oration to deride his conviction that public utterances must be mindful of religious sensibilities. He has made his point very clear and expects that it is taken in good faith in the interest of a peaceful journey.
The herbalist will now open the New Testament and preach salvation, stating clearly that salvation can come only through Jesus Christ and NOBODY else.
The Moslem brother will now start twitching his moustache. The visible and almost revolutionary reflexes of his upper lip can be an indication that sentiments have begun superseding reason, and the outcome could well be tragic now shift uneasily in his seat.
The time has come for him to also express his right to the religion of his fore-bears. He’ll put his hand into his pocket and rise to his feet. The time has indeed come!
This article was first published on Saturday, September 9, 2006
When the cause of a particular problem like sickness, disease, sudden illness, a social issue etc. are not known, it stands to reason that resolving it becomes a huge challenge.
Citizens would understand the government when public announcements are made to the effect that government is trying to find a solution to the issue, even though it is taking a while for it to be resolved because citizens are rational beings.
On the other hand, if the solution to a particular issue is known to everybody but the government for whatever reason, is dragging its feet in resolving it, citizens become frustrated and begin to lose trust in their leaders.
One such issue is the heavy traffic along a section of the Kasoa – Odokor road. A short stretch of bad road between the traffic light at the Weija Government Hospital and the entrance to the entrance of the overhead that leads to the N1, is the cause of the problem but nothing is being done about it, day after day, week after week, month after month. Thus is clearly unacceptable.
Another issue that requires urgent attention is the lack of pavements along a lot of streets in parts of the various Municipal Assemblies. Exercise is a prerequisite for long life and healthy living and for those of us who it has become a way of life, this issue of people putting up structures right to the edge of the drains beside the roads, are making life difficult for us.
We are compelled to walk along the roads, putting our lives at serious risk. Pedestrians should never be compelled to compete with vehicles on our streets and roads. Roads and streets are made for vehicles and pavements are made for pedestrians. That is the norm. Any attempt to normalise a situation where pedestrians are mingling with vehicles is insanity.
It is the road regulations that makes it so and therefore district or municipal assemblies are to take responsibility and ensure that spaces for pavements are not encroached upon. Citizens have rights that must be protected by their leaders and making pavements available to pedestrians, is one of them.
When we hear of teachers having sex with students, it appears it is something recent. It is not a new phenomenon. It has been there since Adam. Perhaps this issue is getting much attention due to the proliferation of social media. It was an open secret in times past when Teachers were in relationships with female students and some married them immediately after completion of school.
Some teachers were also known to be having unholy interactions with female pupils but due to the times that these acts occurred, human rights issues and the awareness around it, allowed such unscrupulous teachers to get away with their crimes.
Now we are in a different era and so a Headmaster is now in hot waters. He is alleged to have raped about 19 female students and as usual, some officials tried to cover it up and are also in hot waters and their actions or inactions in the matter are under investigation.
Why the man has been allowed to roam freely without being arrested is simply mind boggling. It appears that the law applies differently, depending on who you are. This issue came to public attention sometime in August this year, yet the police had not arrested or invited this man for question regarding the rape allegation.
It has come out that he is a Constituency Secretary of the ruling party and the question in the public domain is that, is it because he is a political figure that is why he is still walking around without questioning? I believe in the rule of law so let us hold our breadth and let the proper thing be done.
The police must however be seen to be active in this matter. God bless.
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