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).
Accidental poisoning of children at home, starting point of drug abuse by teenagers at home and uninformed self-medication have one thing in common; in all three unused or unwanted medicines are likely culprits. The harm we cause when we fail to properly dispose of medicines we do not need is crippling.
So many people have out of fear or anxiety converted their homes into mini-pharmacies where medicines that are supposed to keep us alive are stocked. COVID-19 worsened this practice and no-bed syndrome also plays a role.
Some of these medications may end up complicating our conditions as we self-diagnose and treat ourselves with what “the all-knowing “social media curb-side doctors prescribe.
From “blood-thinners” including aspirin to steroids, antibiotics, assorted supplements, ivermectin, hydroxychloroquine and even tanks filled with oxygen have found their way into homes. People including children will now “consume” some of these medicines and any left-overs may be accidentally taken, given out to family and friends with “similar” symptoms etc.
We all run the risk of abusing drugs and unfortunately some may end up indulging in “hard drugs.”
Prior to COVID-19 many of us had turned our homes into dumping sites for medicines and we have now expanded our range of supplies. We seem to develop “unholy” attachments to drugs and end up keeping them for years even when they have long expired. I have had several unpleasant requests to identify a drug that is partly decomposed and has no name on its container. Unfortunately I have on all occasions refused to even make an attempt. My trade may teach me many things about humans and medicines but it also teaches me to be wary whenever I attempt to play Sherlock Holmes especially with medicines that are not labelled.
I took another look at “DUMP”, which is acronym for “disposal of unused/unwanted medicines programme.” I must admit I was extremely impressed with the usefulness of the DUMP. Many countries have tried a variety of approaches including self-disposal but I think the option that is being promoted in Ghana by Dr Edward Amporful, Cocoa Clinic and other patrons is exceptional. In my candid opinion every hospital, company and home should adopt this programme.
All you need to do is to return all unused/unwanted or even expired medicines to participating hospitals. Put these medicines in labelled receptacles or bins that are provided. You do not need to disclose your identity, just walk away because your work is done. The necessary arrangements have been made with the relevant regulatory bodies for the safe disposal of such medicines.
Sounds absolutely simple yet this has the potential to save lives; that baby who could have accidentally swallowed some of these medicines is still alive and the teen who would eventually have been hooked on stronger drugs is spared the agony.
I think bins should be in all offices so that staff could drop off their medicines and the appropriate steps taken. Market places could also have these bins available and locked and properly secured to prevent people taking the boxes away. Even homes can have a similar bin for discarding and then periodically taken to participating hospitals/clinics. Unused or unwanted medicines should not find their way into a First Aid Box, they don’t belong there.
How do we amass “riches” in unused, unwanted or even expired medicines?
• We may not adhere to the right dose of the medicine thus we end up accumulating medicines at home.
• Sometimes our healthcare provider may make changes to medicines especially when we have chronic diseases such as high blood pressure but we do not return the old ones to the hospital but instead keep them at home.
• Sometimes we react to a drug and stop taking it, leaving the excess at home. I am not sure why we keep these at home when we are aware we are no longer going to use them.
• …and now we stock medicines for fear that we may not have access to some when we have an emergency. Our excuse is that many people are hoarding social-media proposed life-saving medication. After all we are all still learning.
In support of ‘DUMP’
• A frequent cause of accidental poisoning of children at home is having unused/unwanted or expired medicines within their reach. I have seen children rushed to the emergency room for this reason. Some were lucky to live while others had their exciting life cut short. Start DUMP today and help save lives. Even adults sometimes end up with complications because they assumed a drug was used for something completely different.
• People tend to play doctor or pharmacist at home because they pass on unused medicines to family and friends. This is often the starting point of uninformed self-medication. Many people are unaware that doses and types of medicines needed do not depend only on having an illness that appears similar to what another person on a particular medicine was given.
• When unused or unwanted medicines are improperly disposed of, they may eventually end up polluting water bodies etc. Start DUMP and make a statement on protecting our water bodies.
• Drug resistance is often a consequence of abuse of medicines such as antibiotics and anti-malarias. Kofi starts medicine required to be taken for one week and feels better after three days so he stops. A few days or weeks later Awo appears to have a similar illness so Kofi gives her the medicines left for four days. The process of developing drug resistance has just taken off.
• Keeping expired medicines at home may lead to unsuspecting people taking them and they may end up with additional problems.
• Improper storage of medicines may affect its potency. A typical example is keeping medicine that needs to be refrigerated in a hot room instead. Return these medicines.
We could jeopardise our health or that of others just because we are keeping unused or unwanted medicines. STOP. THINK. JOIN DUMP TODAY! You will be saving lives.
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
*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 –“IN CASE OF AN EMERGENCY you may need someone to be alerted. Since majority of us own cellphones, plan your own rescue by saving this person’s phone number preceded with “ICE.” An example is ICE Kojo Essel.The more people we have who know about “ice” the better for us all. Spread the news!!”
References/Credit:
• Dr. Edward Amporful, Cocoa Clinic.
• www.healthessentialsgh.com
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
