Death and dying in Ghana: A cry for the beloved country

For a nation not at war, the rate of death and dying in Ghana these days must be of great national concern. Our people are dying too often, and far too soon. The Ministry of Health and the government must convene a national forum to explore the causes of this epidemic of premature dying and develop an action plan for dealing with some of its avoidable causes.

I spent roughly three months or so in Ghana this year and within that period, attended funerals at which up to four people were buried simultaneously, in the same cemetery, in villages whose populations are an average of 1000 people or less. Needless to say, it was a very traumatic time for me. On a visit to the morgue, I counted not less than 12 families collecting their departed in minivans that had been converted into ambulances.

Worse, on my travels to my village on weekends, almost every single town or village I passed seemed to be having a funeral. My understanding is this is replicated across the length and breadth of our dear country each weekend. This level of mortality must be a cause for national concern. Surely, this cannot be what nature intended.

In my opinion, this is a national crisis that requires study and action. I am not a physician and have little knowledge in epidemiology. But common sense tells me this is something that we ought to look into as a nation, to see if we can do something to reverse this trend. I have some uneducated guesses about some of the preventable causes of such alarming rates of death in Ghana and will touch on some briefly here and in greater detail in subsequent posts. Of course, there are some causes of death against which we can do only so much in terms of prevention, if at all. Those are not my focus here.

Preventable and Chronic Diseases

It is now widely known that chronic diseases such as diabetes (called sugar disease in local parlance) and hypertension (BP) have become epidemics in Ghana. The sad part is that most people may be living with these serious diseases without knowing. To some extent, both diabetes (at least type 2 diabetes or the type of diabetes that you can develop as an adult; meaning you were not born with it) and hypertension (high blood pressure) may be partly related to lifestyle choices: what and how much we eat, what we drink, our weight, and how active we are.

Today, the average Ghanaian in the city eats just like an American or European. Canned hotdogs, sausages, eggs and sugary drinks have become the staple breakfast in many “middle class” homes. I am told a trip to Kentucky Fried Chicken or Pizza Hut is a must for those who can afford it. There are several brands of sugary drinks, all relatively inexpensive, that are sold across the country. Growing up, I probably drank a “soft drink” once a year at Christmas. One was lucky if they had a whole bottle to themselves. As a student in secondary school, I believe we went almost a year without sugar being served in the dining hall with breakfast because that was the height of shortages of the so-called essential commodity. I am not going to say we were happy about it, but it probably did our bodies some good. Today, people may be consuming large amounts of sugar all day long. Parents freely indulge their kids with sugary drinks, wrongly called juice. Even pure unadulterated juice is loaded with sugar. What passes as juice in Ghana is nothing more than flavored drinks that are loaded with sugar. Excessive consumption of sugary drinks is linked to type 2 diabetes, obesity and other ailments and obesity is becoming a big problem in Ghana. The Ministry of Health must educate people on the dangers of obesity and excessive sugar consumption.

Lack of Primary Care

In Ghana, most people see the doctor only when they are not well. I was once guilty of that myself. I was surprised when my friends who had been living in the US before I came advised that I needed an annual physical (checkup). I promptly told them I was well, and did not see the need to see a doctor. I did not know then that they were giving me a life-saving advice. We need to start educating our people on the need to use preventative, routine care. I know old habits are difficult to break, but it is better to know you have a disease than not to know. The good news is that even chronic diseases such as hypertension and diabetes, with diligence, can be managed.

The NHIS should make preventative care a cornerstone of its mandate. The NHIS must make provisions for supplying medications regularly to those who have chronic diseases such as hypertension. I am told that some people buy only a few days or a week’s supply of drugs for treating their hypertension because they can’t afford a month’s supply. Yet as doctors tell us, one must continue taking these medications every day.

This is one area where the NHIS needs to focus its attention. Focusing on basic care would save the NHIS millions. I would even give incentives (maybe lowered premiums) to people who have annual checkups. This of course means our doctors need to be educated that time spent on preventative care saves them lots of headaches down the road.

Fake Medications, Drug Abuse and Charlatans

You probably have heard or seen those running infomercials (advertisements) from people claiming to have a cure for every kind of ailment under the sun. Call Mallam so and so. Togbui so and so. I saw a sign near Afienya that read “End of the Road for Diabetes. Please call xxx.” One wished it were that simple. In other cases, I have heard of people peddling all sorts of herbal remedies and using machines to “scan” people for ailments and provide treatments.

The Ministry of Health, in collaboration with the Food and Drug Board, must crack down swiftly on people selling fake drugs and peddling all manner of cures. It is commendable that there is a crackdown underway for quack doctors. We also need to educate the population on the dangers of drug abuse. Even a common pain killer such as paracetamol can be abused and abusing pain killers can lead to liver damage. Yet, it has become routine for people to take painkillers because they think they have a “fever.” We need to educate people to be careful about buying and taking medicine that is not prescribed by a doctor.

Alcoholism

Excessive drinking has become a problem in Ghana. I have nothing against those who drink responsibly. There are no statistics on per capita consumption of alcohol in Ghana. However, my guess is among certain age groups, more than half drink alcohol in one form or the other on a daily basis.

Some of that level of drinking rises to the level of alcoholism when clinically defined. There are others who have this erroneous idea that drinking a little bit of alcohol before meals, “appetite” in the local parlance, somewhat makes the food more enjoyable.

I suspect if the food doesn’t taste good to start with, the so called “appetite” would make no difference. Overtime, small regular drinking becomes a habit, and habit unchecked becomes an addiction. Unfortunately, beating alcohol addiction is no easy task.

The quantity of alcohol consumed is not the only culprit. Even the type of alcohol consumed needs to be examined. Akpeteshie, the local gin, is what distillers call “over proof.” That stuff burns if you light it with a match. Imagine what it does to your liver. I heard that some distillers use nails and all sorts of dangerous things during the brewing to hasten fermentation.

Drinking “bitters” is another craze. Bitters are heavily advertised and relatively cheap especially now that they come is sachets (I wonder what people were thinking before approving alcohol to be sold in sachets). If you look at bitters that have their ingredients listed, cola nut is one.

Cola raises blood pressure and thousands of Ghanaians probably have hypertension and may not even be aware they do. The so-called natural flavors and ingredients in bitters may be interacting with medications people are taking. No one knows about the side effects, yet we joyfully consume them for “appetite” and for other reasons.

Alcohol, even in modest quantities affects our body and excessive alcohol consumption can lead to liver disease and I am sure alcohol plays a role in thousands of deaths in Ghana every year. Sadly, even as I write this, someone may be dying as a result of alcohol abuse. Education, and regulation of the sale of alcohol can help stem this epidemic.

Speaking of drinks, energy drinks are another popular trend. Drinks such as Red Bull have the equivalent of 1 cup of coffee with 80 mg of caffeine. Caffeine drives up your blood pressure and these so-called energy drinks may be doing more damage to your heart than you can imagine. If you must drink them, please do so in moderation.

Road Accidents

A recent global study listed Ghana among countries with very high risk for death through motor accidents. I guess that should not come as a surprise to any Ghanaian. Most people probably know someone who has unfortunately died as a result of a car accident.

Of course we don’t have to look far to know the causes of road accidents. As is the case with most of our national life, there is very little respect for laws. Vehicles that should not pass the most basic road worthiness test ply our roads.

Cars and trucks, most old and rickety, are grossly overloaded. Most of our roads are bad. The few that are good are abused by drivers who over speed and overtake other driver’s recklessness, causing accidents and death.
Ghana is an ill-disciplined nation and I owe no one any apologies for saying so. Ironically, this is a nation that had waged a “war” on ill-discipline in the not too distant past. The irony is never lost on me. There are rules of the road and these are there to safeguard the welfare of all drivers and passengers. Yet, you just need to stand on any street corner or better yet an intersection, to see how people drive in Ghana. Drivers make their own rules, run the lights, make turns without warning and generally act as if they were driving on an empty race course with nothing to obstruct them.

The Police should make an honest commitment to enforce the rules. In the US at least, you only get stopped if you violate the rules. Setting up road blocks has not accomplished anything and accidents continue to happen in spite of the road blocks. Maybe it’s more productive to focus just on those who violate the rules.

Prayer Camps & False Promises

I am not qualified to analyze how and why religion, in all its manifestations, has become the very air we breathe in Ghana today. I have nothing against religion. I have had my fair share of immersion in religion, having spent seven of my formative years in a Catholic run secondary school that required compulsory morning and evening prayers, seven days a week, masses not included.

I also have nothing against those who choose to lead their lives in prayer or stay in prayer camps. What worries me is the now too common practice of taking sick people to prayer camps instead of to hospitals.

These pastors are not doctors. They have no medical training and much harm can be done to people who may have chronic diseases such as hypertension and diabetes and may not be aware that they have the condition. People may know they do not feel well and erroneously believe prayers would heal them, but the doctor is probably in the best position to diagnose and tell you what may be wrong, not your pastor.

I suspect that your headache would go away faster if you take one paracetamol and pray in addition, instead of prayer alone without any medicine. Same for your blood pressure. Pastors may have their reasons for keeping sick people in prayer camps. But they are not really helping the sick. They may merely be worsening the situation and hastening the development of complications and unfortunately eventual death of the sick.

Medical Negligence /Lack of Care

The quality of care in some of our hospitals leaves much to be desired. My 18 year old nephew died this past August under circumstances that would certainly have led to a law suit for negligence in any developed country. You do not have to be a lawyer to know negligence when you see one. I know there have been a few cases of hospitals getting sued for negligence in Ghana, but those are the exceptions rather than the rule. But times are changing.

We know that health professionals in Ghana are overworked but that cannot be an excuse for not delivering proper care. I think the Ministry of Health must compile and publish data on hospital mortality rates, per hospital each year. We need to know how many people die each year in every hospital. Hospitals are not to be blamed for every death. However, that kind of data can tell us something.

Medical science and therapies are evolving by the day and possibilities exist for our healthcare professionals to benefit from these advances. There are hundreds of Ghanaian doctors abroad. The Ministry of Health must set up a skills bank, and link these doctors with practicing doctors in Ghana so they can exchange ideas and transfer knowledge and skills.

Our younger physicians would especially benefit from mentorship from older and more experienced physicians. Interactions of that nature can only benefit care delivery and the beauty is this sort of cross-learning and mentorship can now all be done online.

And Finally
I am not a physician and so there you have my uneducated list of causes of preventable deaths. The good news is that each one lends itself to some form of intervention. I hope this piece starts a debate on our airwaves, radio, TV, online, in churches, parliament and in our towns and villages. Perhaps you have your own ideas on what is causing this epidemic of death and dying in the country. Add it to this list. More important, let us urge the Ministry of Health and the government do something.

Please pick this message up, share freely with others and let us start a conversation because this sad state of affairs affects all of us eventually. You should care because every life matters. To paraphrase the now often quoted verse of John Donne, "No man (or woman) is an island.

Every death diminishes me (all of us) because we are all involved in mankind, and therefore never ask to know for whom the bell tolls; it tolls for thee." We rise and fall together as a nation and we can no longer pretend that we do not know the extent of this calamity. Together, let us look for solutions. We certainly can do much to prevent some deaths and each life saved is one less tear we have to shed.