Feature by Godfred A. Polkuu
Bolgatanga, Nov. 22, GNA – A beautiful modern edifice for a hospital by every standard. The Bolgatanga Regional Hospital also known as the Upper East Regional Hospital is the major referral Centre and a first point of call for emergencies of all kinds of health related incidents, yet has no Doctors to manage specialist cases.
It is horrifying to know that the 206- facility designed to serve a population of about 1, 124, 193 has just seven Doctors, whereas it needed 30 Doctors at least, to manage the health needs of the people.
Clearly, there is a big challenge at addressing the health needs of the people in the Upper East Region, considering the threatening and volatility with which patrons of the hospital are exposed to.
Glaringly, the hospital is seriously battling its core mission statement to “offer quality health care to all persons living in Ghana, and delivered by well-trained, highly motivated, and client-focused health professionals”, because seven Doctors positioned under this horrifying conditions cannot breakthrough to achieve this laudably stated mission of the facility.
This feature therefore seeks to examine the reasons why only seven Doctors live and work at the biggest referral hospital in the Upper East Region, when that facility needs 30 Doctors and more to contain the clientele population of about 1.5 million.
Established in 1902 to cater for the health needs of the minority white population in the then Gold Coast, a protectorate of the British, the Health Centre, as it was called, provided mainly orthodox medicines.
The experience of colonial rule in the southern part of Ghana guided the British to move with a small team of medical personnel to provide health care services to only the white minority.
With time however, infrastructure of the Brits expanded in the area and the black population that willingly cooperated with the Brits started benefitting from orthodox medical care together with their families.
The current site of the regional hospital was started in 1946 as a health centre to continue service to the whites and some few Gold Coasters working for the British and very few indigenes.
From the 1946s the hospital was expanded and given a bigger role to manage the health needs of the people with a team of five Brits ( names not available), made up of a Physician's Assistant, two nurses, and two health Assistants.
However, their numbers started increasing as more expatriates came around and more blacks aided them in their work.
Blacks started working in the Centre from 1946. They were basically Ghanaians who had their training in nursing and Physician Assistantship in the UK as there were no adequate training facilities in Ghana for that. All these while, the management of health care was entirely in the hands of the expatriates.
The first Ghanaian doctor called Dr Johnson, a Fante, was posted to the hospital in 1955 and assumed headship of the health centre. The Senior Nurses were still whites with blacks serving as Nurse Assistants. Dr Johnson died in 1961 and was succeeded by one Dr Gandaa.
The construction of the bigger facility upgraded to Hospital was completed in 1946 from where it is currently located and was opened to the general public. However, the indigenes rarely used the clinic. Instead, they preferred traditional African medicine.
Today, the Regional Hospital has total staff strength of 612 out of which 491 are permanent and 121 temporal. Confronted with an uncontrolled population growth of 2.6 and estimated current demography of about 83.4 percent, it is disheartening that the Upper East Regional hospital today lacks doctors to comfortably execute its core values despite its progressive expansion and scope of services from successive governments of Ghana.
The 71-year-old facility ideally should have come to a halt considering the Doctors as core managers of the facility around whom every important work on the patient rest.
Sometimes, one is tempted to doubt if there shall ever be any breakthrough on the targeted achievements so focused by past and present management of the hospital as it holds the vision “To become a well-resourced regional referral hospital; with adequate physical infrastructure, adequate number of well trained and highly motivated human resources; and the needed modern technology, systems and processes to provide secondary and tertiary health care; as well as adequate facilities for medical education and research.”
Surprisingly however, the hospital runs wide range of services in spite of its numerous challenges. The success behind what it has achieved so far rests on its untiring, business focused sacrificial oriented professional dedicated staff (even though under staffed), and headed by a strong human centred Paediatrician with solid backing from professionals constituting its Management team.
THE GNA OBSERVATIONS AND CHECKS
Several visits to the hospital by the Ghana News Agency (GNA) to establish why people seeking health care spend hours at the facility before health delivery, revealed that one doctor attends to about 300 patients daily. It is not surprising that patients spend virtually the whole day at the facility to see the few doctors who practically sleep at the hospital to save lives.
For instance, the Paediatric Unit of the hospital has only one Medical Officer, Dr Ernestina Addah who sees a minimum of 60 children on admission a day, and still does consultations at the OPD throughout the seven days of the week.
Dr Patrick Atobrah, Medical Director of the hospital, usually support her with rounds at the Unit, especially on Saturdays and goes on to other units for same duty-call ward rounds, and further perform surgical procedures assisted by a Medical Officer, who has completed his house officer’s job at the hospital and only sacrificing by giving support and augmenting efforts of the skeletal Doctors at the facility pending his posting.
On several occasions, the Director moves to the facility as early as 0300hours to start consultations all in a bit to reduce the congestion, and afford patients easy access to health care at the hospital.
From a distance, one would be tempted to conclude that patients enjoy to seek health care late at night, the fact is patients, especially women with their children queue as early as 0600hours for folders and still queue again to see a doctor who would usually be on ward rounds.
The Regional Hospital, which equally suffers the challenge of dwindling financial resources and undue delay in reimbursement for National Health Insurance Authority claims, coupled with inadequate human resources, characteristic of most health institutions, the facility in the face of these challenges made remarkable progress in its quest to improve on the status of its clients.
Checks by the Ghana News Agency again at the facility revealed that there was growing confidence by clients in the health delivery facility manifested by its Out-Patient Department (OPD) attendance of 8.3 per cent and improved quality of care resulting in general decline in mortality although admissions increased by 8.4 per cent in 2016, while majority of its clients were subscribers of the National Health Insurance Scheme with 97.5 per cent for OPD and admissions respectively.
The checks further revealed that there was significant improvement in maternal and newborn care as the hospital delivered more babies in 2016 than it did in the last four years and still recorded the lowest maternal mortality in the same period.
Speaking to the GNA in an interview, the Director of the Hospital, Dr Patrick Atobrah, said the facility currently has a Paediatrician and a Gynaecologist without Surgeon and added that the absence of such a vital specialist at a hospital of such grade was not befitting and confirmed that the facility would need 30 medical doctors of various disciplines to function effectively.
Dr Atobrah hinted that “we do not easily get doctors at the Out-Patient Department” and appealed to government to post more doctors to the facility to ease the pressure, since the hospital was run by only seven Ghanaian doctors including three Cuban doctors made of an Intensivist, Gynaecologist and a General Practitioner who were currently on vacation in their home country.
The Medical Director, who is a Paediatrician, said although initiatives were put in place to attract doctors to the area, the hospital was constrained and could not fund such initiatives and reiterated the need for government to intervene.
Dr Atobrah advised young doctors to accept postings to the Region, especially to the Regional Hospital disclosing that “they will see all the conditions they learnt from their textbooks manifest in patients, and would boost their level of experience than staying in the urban centres.”
He expressed concern about the lack of water supply to the facility as most of the units had no source of water to run the hospital’s daily activities adding that “although the Region was deprived, its natives were Ghanaians and deserved the maximum comfort in seeking health care services.”
Apart from the lack of doctors, which is one of the major concerns to management, the facility has only one X-ray Technician and four Pharmacists, the former, according to the Director, had worked alone for about 10 years.
This, he said exerted pressure at these units, especially at the pharmacy and laboratory, where the GNA observed was usually choked by patients waiting to be served.
Mr Zakariah Yakubu, Head of Administration speaking to the GNA, appealed to duty bearers to ensure that Medical Doctors posted to government facilities reported without fail.
He prescribed decentralisation of appointments to the Regional level so that when doctors turn out every year, they are distributed accordingly, and opined that “If you post someone and the person refuses to come, no government hospital should absorb that person.”
Mr Yakubu called on government to institute special packages for doctors who accepted postings to deprived areas as a means to motivate them to stay at rural areas where their services were most needed.
He said peace is a cardinal component that would further attract people who may want to work in the Region, and appealed to stakeholders to uphold the peace in the Region to attract professionals, especially doctors to the area.
Even though the dispensary has been split into two sub-units with one serving In-patients and the other Out-patients as part of measures to ease pressure, the situation will remain the same if more pharmacists and dispensing technicians are not posted to the hospital to remedy the situation.
To further acquaint itself with issues of the facility, the GNA was surprised that almost all the units including critical ones, depended on what the nurses call “Veronica Bucket” which compelled dedicated and self-motivated staff, especially nurses to carry water, from overhead tanks situated at vantage points to fill them in order to improve health delivery.
No wander its mission statement is to “offer quality health care to all persons living in Ghana, delivered by well-trained, highly motivated, and client-focused health professionals”.
Health, it is usually said is wealth, ought to be taken seriously by all stakeholders in the region if the Regional Hospital must remain a referral point for all ill health cases in the Upper East Region.
The Tamale Teaching Hospital, a major referral hospital for the three regions in the north of Ghana suffers series of unnecessary congestions because simple ailments and conditions that could be handled by a minor referral point like the Regional Hospital in Bolgatanga are sent to the already chocked Teaching Hospital in Tamale to compound the already stressed Doctors and other specialists.
As suggested earlier by the Head of Administration for regional level postings of health professionals to be decentralized, a steadfast decision by the country’s health Management authorities to insist on Doctors staying at post and punishing those who refuse to accept postings are done under the decentralized regimes.
A fine could be slapped on recalcitrant Doctors, they could be banned from practising for some years, and facilities that accepted their application to practise could be liable to fines and other deterrent punishments.
Special packages should be designed, especially for Doctors who accept postings to rural and deprived communities. These motivational packages should not only rest on the facilities.
The Ministry of Health which is the decision-maker for all health institutions should take the initiative to design the package attractive enough to motivate and sustain Doctors who accept postings to rural and deprived communities and the Regional Hospital in Bolgatanga.
These packages should be extended to other health workers including; Nurses, Biomedical Scientists and laboratory related staff, paramedics, and any other group of workers in the health sector helping to save human life.
A second look should be given to one worrying issue confronting the health sector; which is the movement of Doctors from the consulting room to do administrative work.
Dr Atobrah, a Doctor and Administrator’s case may be unique as one cannot decipher his roles as consulting Doctor and Administrative Doctor. Where a Doctor decides to limit him or herself in such situation to do Administration, especially in a facility struggling like the Bolgatanga Regional Hospital, it is the innocent patients that suffer these consequences.
If health is wealth, then managers of the country’s health sector must begin to overhaul the sector for the citizenry to appreciate the health needs in order to begin to create the wealth we all vie for. A health to the wise is in wealth.