There is the need for the public to be aware of what it takes to save a life at the hospital. All professionals of the health team needs to be recognised and given their share of respect and recognition. The phrase used in the title of this article ‘the Ghanaian Hospital Monopoly’ seeks to discriminate between the global understanding of this term and what I intend to convey by it.
What is the Ghanaian Hospital Monopoly?
As used in this article the term refers to the efforts being made by one professional body to hamper the progress of another in pursuit of public glory or personal interest. As a member of the health team I have often engaged members of other professions trying to find out their grievances and dissatisfaction as part of the hospital system. What I learn from these endeavours suggests that if efforts are not made to streamline activities at the hospitals, the unsuspecting Ghanaian tax payers will always be at high risk attending our hospitals.
But Let’s not start off on the wrong foot
This Ghanaian hospital monopoly is not to say there is no professional politics going on in the hospitals of other countries in the developed worlds. The difference however is that in the developed world these professions have roles specified and followed strictly. In Ghana however even though the job descriptions exist, they clearly are not being followed.
Who constitutes the health team?
Let’s take a scenario to help us understand how it takes not just one but all the health team to save a life.
An accident just occurred in town involving a 20 years old guy -Wumpini
The ambulance service has been called upon. The driver and the attending nurse risk their lives driving through the traffic as if they had a spare life. The nurse provides the needed first aid on the victim. The emergency attendants moves Wumpini into the vehicle. The nurse continuous the service till they arrive at the hospital.
Emergency technicians wheel the nearly unconscious young man to the emergency ward where the trauma nurses takes over. If there is a medical doctor (MD) around they assist in the process. A team from the laboratory comes to take blood samples or in some cases the attending nurse of physician does. The nurse cuts out Wumpini’s clothing to allow space for further treatment.
Now he has to be examined thoroughly
Wumpini’s neck and chest are X-rayed by a radiology technician. The records secretary puts medication orders into the computer so a pharmacy technician, working with the pharmacist, can prepare the appropriate medicines.
The MD handling the cases has to be the central decision maker! They make all the vital decisions based on the feedback from the other fields. They wait for all clinical data to come in so they can make the best decision for the patient.
Soon the medical laboratory full blood count, renal function and clotting profiles reports comes in. the doctors combines this the radiology reports and realizes Wumpini had a broken rib and hip! The attending MD or sometimes a senior nurse of medical assistant calls on the surgery nurses to prepare for the patient. The trauma technicians help to move the victim to the surgery unit. The clotting profiles from the laboratory helps the team decide what to do prior to the surgery.
Surgery nurses and physician assistants stand by to help in the process. The surgeons undertake a successful surgery after a few hours. The surgery concludes, the operating room nurses wheel him into the recovery room. The operation room at this point has its floor covered with used gauze sponges, suture ends, and a splattering of blood, the cleaners enters with disinfectant, a mop and a bucket to make sure it’s cleaned and prepared for the next patient.
The attending medical doctor walks to the waiting room to inform the patient’s relatives that everything is okay, Wumpini is stable and should be fine. Wumpini’s father hugs the doctor in joy and says “Thank you for saving my son’s life”. The doctor takes the glory and heads back to take another case.
But for the nurses, laboratory personnel, the pharmacy the cleaners etc, it does not end here! The patient has to be continuously monitored and cared for by the nurses. The medical laboratory have to run post surgery tests to help in the monitoring, the pharmacy will continue dispensing the drugs
The MD checks in intermittently for monitoring but the majority of the work is done by the nurses and other health professionals. The cleaners helps in ensuring that does acquired a hospital born infection.
What is the message from the scenario?
It takes more than one to save a life but the hospital like a ship requires a captain. The medical doctor is the captain of the team. This is because someone has to coordinate all the team players towards the betterment of the patient. The MD remains the centre point for medical care but that does not mean their role is more vital than the rest. As evident from this scenario one role is as vital as the other.
Unfortunately in Ghana, the MDs seek to use the public recognition as a yardstick to down play the efforts of the other team players. The government helps in compounding this problem by listening to them over the other professional bodies. This leaves them generally disgruntled which is affecting the quality of healthcare delivery in this country.
The most recent issue was that with the Ghana medical laboratory policy implementation. The Ghana Association of Medical Laboratory Scientists in conjunction with other stake holders was assisted by the Centre for Disease Control and Prevention (CDC) to draft a policy document. this was meant to govern and control the practice of the medical laboratory science in Ghana. The document was later signed by the ministry of health in 2013. The Medical and Dental Council of Ghana came out against the document stating that some components of the policy were against their interest.
What was their interest?
Their objection was mainly around the leadership of the medical laboratory. They think that to head the laboratory you must have an MBCHB. It is like saying that to be a headmaster of a senior high school you must have a degree in Law. Unfortunately as absurd as this sound, the past government actually took that into consideration and the policy wasn’t implemented. The association called for a sit down strike action but it changed nothing. Up to today, the policy document Ghana spent resources to draft is still gathering dust on the shelves of the ministry of health. The signature of the former minister of health Henry-Sherry Ayiteh is rather serving as a decoration rather than a symbol of authority . This was a main subject at the recent congress of GAMLS
The policy was only meant to standardise medical care! It was meant to strengthen the diagnostic sector. Why will one member of the team sabotage the development of another if really they have a common goal of patient satisfaction? And this is just one of many. Medical doctors struggle against pharmacist .they struggle against the nurses and if you have worked at the hospital I do not need to over stress this point. The other professionals are not too concerned about their frequent strike actions even though it is well known they are the most paid. So why should they be concerned about the development of others?
So what is the consequence of this unchecked monarchy of the health care system of Ghana?
A disgruntled worker can only be sustained by his passion for a while. If nothing is done the most obvious consequence is poor service. If workers continue to feel that the system is against them and nothing they do seems noticed, it is only natural that they will seize to put in their best. They will go to work with a stern of apathy and dissatisfaction.
Also, experience is one of the non-negotiable qualities that every proper healthcare system requires. Unfortunately, the most experienced of the medical laboratory, pharmacy, or nurses usually either goes back to school to become a physician or an academician. They do this because they think their efforts deserve to be noticed. They do not want to come and be second citizens under professionals they have more experience over.
For instance, why will a fresh graduate from the medical school earn more than a senior nurse who is required to train him further?
With the medical laboratory, a PHD holder in hematology does not have much different role from bachelor degree holders. This is because the government does not give the sector the necessary attention. So instead of coming back they prefer to send their experience to the academics, starving the hospital off the much needed experience. In consequence to this, the diagnostic sector never moves forward which inevitably affects the entire healthcare delivery.
There is professional doctorate of medical laboratory and pharmacy in this country now despite several attempts from the GMA and other associated professional bodies to sabotage the respective developments. But what is the government of Ghana going to do about this new development? Are they going to continuously dance to the tune of the physicians or they will use the healthcare system of the developed world as case study?